Sunday, September 8, 2013

Proper and Judicious use of HEMS

                Tell me you haven’t had this discussion on the truck before.

911 Dispatcher “Small Town Ambulance Service Call, Middle of nowhere. Small Town Ambulance please respond to a 2 vehicle MVC head on, unknown injuries”
JG “County Dispatch Rescue 51 is enroute do we have any word on injuries”
911 “Unknown at this time 51”
JG “51 is clear.”
RD “JG Should we get F&U to send mutual aid”
JG “RD Why don’t we launch a bird, we know how bad it can be out there.”

       Herein lies the problem. Helicopter EMS is a growing and vital service in rural America. It is also overused, causing increased costs with no benefit to the patient. Helicopters save live, I truly believe that. There is very good evidence that they do in rural settings. The jury is definitely out in urban ones though. So in typical EMS fashion there are some of us that take it to a ridiculous extreme. I mean oxygen helps, so let’s put more people on more of it. Wait, there is evidence that Oxygen has negative effect on CVA patients increasing mortality.

      Helicopters are a finite resource that needs to be used judiciously. There needs to be sensible guidelines for HEMS usage. So in the interest trying to improve this, lets look at some sensible guidelines.

Lone Medic’s HEMS Guidelines

Helicopter should be considered in the following situations:

Pt. requires higher level of care than is available locally.
Helicopter can be at scene before EMS unit can have patient at a local hospital for stabilization
Pt. is suffering from immediate life threatening illness or injury.

Consider ground transport in the following situations:

You are able to arrive at an ER before the Helicopter is able to be on scene.
If you are able to transport a patient to an appropriate facility in less time than a Helicopter can.
If the Patient has non-life threatening illnesses or injuries.

        Now you notice that I stated that if you can have a patient to an appropriate facility before a Helicopter can. I know your ask, LM aren’t Helicopters always faster. Well let me take you through the process of activating a Helicopter in a STEMI situation. Something I think is appropriate, if time is saved.
Upon arrival you find a patient is having a Anterior Infarct after performing a 12 Lead ECG. You know there is a Reperfusion center 35 minutes away. Being a caring medic you contact the Helicopter. 3 minutes later they accept the flight and weather is clear. You give them the GPS coordinates and the backyard is clear enough to be a effective LZ. 10 Minutes later they lift off. They have a Flight Time of 15 minutes. After they land it takes the flight crew 10 minutes to prepare the patient to for lift off. They have another 10 minute flight to the Cath Lab. Diagnosis to balloon approximately 55 minutes depending on where the Lab is in the hospital. You could have had the patient there in less time, saving 13 minutes.

       This does not mean you shouldn't utilize HEMS, like I said they save lives. But use them judiciously. The other problem I have is using them when they are not needed. Mitchell Mightymedic gets called out to a man who fell off of a ladder and has a Tib-Fib fracture. Patient is hemodynamically stable with good pedal pulses. Mitch decides to fly this patient to a trauma center due to a  transport time of 24 minutes to the nearest facility.

       During this time, Gina Ditchdoc is called out to a ATV accident that requires a 25 minute ride on a Fire Department rescue UTV. Upon arrival Pt. is found to have systolic BP of 84 and an unstable pelvis. Gina contacts dispatch and there is only Helicopter available is 1 hour away due to Mitch’s patient being enroute to a nearby Trauma Center.

       Helicopters are also unable to fly during lightning, high winds, or other inclement weather. Do not delay transport to ask for a helicopter that is obviously unable to fly. If it is that time sensitive, they need to be in a Doctor’s care.

Your Feedback is always welcome.

Lone Medic.

Tuesday, September 3, 2013

Lights, Sirens, Stupidity

It has been a while since I posted. During that time I started a second job. My wife has started the journey that is Paramedic Class. I honestly envy her in this, as her program is far superior to mine. If you have read my posts before you know that I am an advocate for improved education for EMS in Illinois. But there are changes that need to happen on the personal and agency levels as well. Personally, I want to drop at least 80 pounds by June of 2014. I have changed ADD Medication to one I tolerate better, which helps me in this goal.
But this is not my personal blog. This is for my profession and how to improve it. The subject that I am about to discuss is one I have personal experience in and how it can go bad. I am going to discuss Vehicle Operations. When I first started the culture was based on drive fast, seconds count, and damn the consequences. That was wrong. I hit another vehicle while driving non-emergency. There were numerous close calls. I once made a normally one hour and forty five minute trip in 59 minutes. Folks, I was a menace.
You combine this with sleep apnea, multiple 24 hour shifts in a row, and my ADD, well it is a miracle I never killed someone. I tell this as one of the lucky ones. I now have the ADD and the Sleep Apnea under control. I have my shifts scheduled so I usually am able to sleep an adequate amount. These things improve my safety as well as the safety of those around me.
Now I mentioned a second job, it is with a really large EMS provider. I will leave it at that. Their driver’s safety program is not quite as extensive as I think it should be, but it definitely works. Every EMT and Paramedic should be taught low forces driving. Every EMS agency should have an effective driver monitoring and feedback program. This is something that will save our lives. Driving is without a doubt the most dangerous activity EMS personnel take part in, and we forget it.
Remember this if you are operating an ambulance and you kill someone, you might not be held legally liable. Different states have different laws about this, but you most likely wanted to save lives when you started in this. Do you want to be the guy that has to face the fact you killed someone. That person you kill could also be yourself. Do you want your friends and family to live with that loss?

As always I value your comments and opinions,

Lone Medic.