Aviation requests within the TOB?

[belmontcapt]

I have been reading the past few months and noticing that Dept's. within the TOB have been requesting Aviation more and more. Now I am not trying to start a fight. I am not Monday morning quarterbacking anyones decisions to fly someone, but why do we? We have a trauma center usually under a 10 min transport from anywhere within the TOB. My thoughts and my teaching's on trauma is that it is a BLS call unless we come into a airway issue with the patient. Yes we can give IV fluids for Hypotensiive patients but you do that on the run which was how I was trained. Yes the flight medics do carry Paralytic medication to assist with intubation's in the field but why do we wait? Just throwing this out there and seeing what other people think.....

[STP82]

Are they calling for aviation or just asking for aviation to standby? The resaon I'm asking is that SCPD notified dept's that their new birds need more time to warm-up prior to flight. They asked that if there is a possibility of needing them that they be alerted right away for standby. Not sure if that's the answer, but maybe one possibility.

[Billy Buff]

Capt, I've been saying the same thing. And especially now with aviation taking longer to get to the landing zones, why wait? The only thing I see aviation good for in the T.O.B. would be a burn victim or maybe a MCI with multiple trauma victims. Just my thoughts

[belmontcapt]

I understand the new protocol about warming up the bird and yadda, yadda, yadda but I am refering to actual requests for aviation from FD's and then driving to the LZ for 3 min and waiting another 3 min for it to land and then another 5 min for the flight medic to assess the patient then take off again another 3 min so now we are talking about an additional 10-15 min of delaying transport to a local trauma center when by ground it would have taken 7-10 min to transport to the local trauma center. For burns i have ground transported with an escort to NUMC under 15 minutes. I hate to say this too but in "NYC" eastern Queens patients get transported by ground to NUMC in about 20 min. I would hate to see a patient decompensate and get a smart lawyer and one of us getting sued for delay of patient care when we have a local trauma center we all respond to. I vote save the birds for the people who need them our east end brothers and sisters where they have nothing and they can easily fly out a STEMI or trauma patient.

[suddenlyseemore]

1: Unless they need specialty care that only a Level 1 can provide (re-implantation, burns), they should probably go by ground to the closest trauma center

2: I don't think 90% of the people on the board understand 90% of the words you've used

3: Bryan Bledsoe has some excellent presentations on the misuse of medical helicopters (http://www.bryanbledsoe.com/handouts.html see "Medical Helicopter Accidents" and "Controversies in Trauma Care" and "Myths of Modern EMS")

[chunkylover53]

Trauma is not an ALS sport. Trauma patients need doctors and sugeons, not buffy ALS providers who stay on scene for extended amounts of time. Also, 5 min to the flight medic to asses the patient is being VERY kind...

[bfd732]

And by buffy ALS providers I assume you mean those other than the one's who have already posted their opinions here? Like so many other things in Fire/EMS is there not some discretion given to the guy making the call who has all the info. at the scene? Anyone other than that is just playing Monday AM Q-Back.

[jjklongisland]

My thoughts: Obviously every situation is different. If you have an mva with a patient that has obvious tramatic injuries and the mva requires a 10 to 15 extrication, calling for a bird might not be a bad idea. If no extrication is required or vehicle vs. pedestrian etc, I think ground transport is the way to go. You also have to take into consideration traffic and time of day. Rush hour traffic even with an escort can be tough, the bird may be the better way. I am not medically trained and this statement may not be correct but I dont believe the birds are any more medically advanced with life saving equipment than a bus, if you have ALS or a paramedic on scene I think it would be easier to treat a patient in a bus rather than a cramped chopper.

[cowboys2005]

now the new procedure is for any delta mva or any trauma call, firecom now puts the bird on standby so i'm assuming it speed up the process,i know at work they have called to tell us it's on standby. you can always cancel with the sector car on scene. Any thoughts

[bfd732]

Having no medical qualifications myself is there any advantage to using a regional trauma center versus a local TC? How often are cases transferred after initial admission?

I fully understand and agree that the sooner you get to MD.'s and hospital resources the better, I'm just trying to rationalize in my mind why we need EMT's at all if we are going to scoop and run.

[grayrider]

Someone said it once before. It would be nice to have a helicopter stationed at Republic Airport for the Western Dept's.

[belmontcapt]

Advantages for level 1 vs level 2 trauma centers? I cant find anything documented in Suffolk County EMS SOG's stating the patient has to go to a level 1 trauma center. I still vote we leave the Birds for the east end lol Now for patient care studies show (I know James will back this one up) That ALS really doesnt do much for a trauma victim. If it is an airway issues yes certain agencies do carry medication for sedation to aid in intubation for the patients resp status. Here is another question I hear conflicting stories and answers in UHSB a "Burn Center" or "Burn Unit" and the only true "Burn Center" on LI is NUMC anyone have any documentation on this?

[suddenlyseemore]

UHSB is a "Burn Center" per DOH: hospitals.nyhealth.gov/browse_view.php?id=40

Here is a list of all Burn Centers in the state: hospitals.nyhealth.gov/browse_search.php?form=CENTER&rt=4

and belmontcapt is right, all trauma is BLS primarily. they don't need an als provider, they need a surgeon, hot lights and cold steel.

the current school of thought is shying away from the concept of wide-open IVs for trauma patients and instead titrating to a blood pressure of between 80 and 90 mmHg systolic. at this level of permissive hypotension certain levels of bleeding will stop on their own.

giving a large normal saline bolus bolus will just raise the pressure again and restart the uncontrolled hemorrhaging.

saline boluses also dilute the blood and can negatively affect platelet aggregation which is going to prevent clotting of injuries.

what trauma patients really need are surgical correction ("a chance to cut is a chance to cure" goes the saying) and blood.

[jjklongisland]

I agree with alot of your points... I guess the main point is get the patient to the hospital the fastest and safest way.

With regards to departments that do not run EMS, whos call is it for the bird? I know pd requests it sometimes but is it the Chiefs call (incident commander) or EMS's call?

[suddenlyseemore]

EMS is responsible for patient care, including how/when/where the patient is to be transported.

[wjb730]

Yes Trauma does need Doctors and Sugeons, and The Hospitals around our area (GSH and SS) Do NOT have those Doctors at the Hospital. Those Doctors are on call, which means you have to wait for them to arrive at the hospital. While at SBUMC, they have Specialty Doctors in all areas with-in the hospital 24-7. Thats why if I believe that the Pt may have any internal bleeding, Amputations, etc. and Has a stable airway. I will most deff call for the bird to take the pt to the Level 1 trauma center. even if it takes them an extra 3-5 minutes.

[belmontcapt]

1) You are correct about the staffing.

2) Many things can happen in 3-5 minutes while you delay transport.

3) Suffolk County DOES NOT specify what type of Trauma Center you need to go to. If they said you need to bring ABC to these types of centers and XYZ to these types we would all be OK. Which means you get a smart lawyer and the patient decompensates while you are waiting that extra 3-5 mintes when in some cases your could have been at GSH or SSH your at fault.

[bfd732]

Liability is key, but let's face it if people start suing VFD's on LI this is likely just one of many areas that may be in question. Does anyone know of a dept. or an EMT that has been named in a suit?

[belmontcapt]

I still say keep the birds for people who need them mostly the citizens out east who have nothing near them... I heard a Dept yesterday try and fly out a finger amputation. Thankfully someone got smart and ground transported I think to UHSB...

[DILLIGAF51]

First off, under Suffolk County protocols, you are supposed to save 10 mins off transport time to use the bird. Realistically, I know thats a soft number, but that is your general guideline for time. I find it hard to believe your gonna save significant time using the bird in TOB considering Good Sam, NUMC etc are right there.

However, the bird isn't always requested for just transporting patients. As said before, if you have an unstable airway from trauma, call for the flight medic. They are able to do ten times as much as a volly paramedic can, even under standing orders. Just keep that in mind. Most of the time they transport by ground because its easier to work with. Even so, BLS before ALS in trauma, just grab and go

Cowboy, the bird doesn't get put on standby for all delta mva and such. It is at the discretion of the dispatcher at the fire/rescue PSAP that takes a call if aviation is needed. We all know those calls where some body gets tapped by a car and hurts their foot and it goes out as a delta. If the dispatcher feels the call is bad, aviation get put on standby, and generally they are pretty spot on.

[cowboys2005]

thanx tj for the clarification

[suddenlyseemore]

if you have an unstable airway from trauma, perhaps you should be transporting rapidly to a hospital where they can put in a definitive airway and then transfer to a more comprehensive facility

perhaps instead of notifying aviation to respond to the scene, could the helo be used to transport a pt from one hospital to another after they have been initially treated and stabilized? or notify UHSB's ambulances to start responding to the initial receiving hospital with a crit care RN and medic on board?

[belmontcapt]

"They are able to do ten times as much as a volly paramedic can"

Well for know but as time goes by more drugs are going to be available for medics so they can RSI. If your just going to wait and DELAY patient care for the flight medic's Paralyitics then you shouldnt be touching patients. Also if your in the Town of Islip the NS Medics do carry medications for airway control.

[DILLIGAF51]

belmontcapt said:

"They are able to do ten times as much as a volly paramedic can"

Well for know but as time goes by more drugs are going to be available for medics so they can RSI. If your just going to wait and DELAY patient care for the flight medic's Paralyitics then you shouldnt be touching patients. Also if your in the Town of Islip the NS Medics do carry medications for airway control.

Absolutly right cap...never wait on a bad trauma call for anything. If the resource is there, use it, if not then grab and run like hell. Like I said before, BLS before ALS...

[fire2li]

I remember a few times where the PD called for aviation " FYI in a statement sent out by the PD if the arriving officer feels it should be aviation they will put it on standby"before we got to the scene, and we transported our selves just becasue it was in the patients best intrest to get to the hosp. quick.

[Luke]

Maybe someone can clarify, when putting the bird on stand-by, what is actually done? Does the flight crew file a flight plan during this time or is this saved for after the actual request is made for the bird to fly? Do they fire up the bird when they get put on stand-by or do they wait til the are a go to fire it up?

[bloomtruck42]

i'm pretty sure its a heads up for the crew... if they want to get it up in the air and head in that direction they can-- as far as a flight plan i'm not so sure they need to file one, i dont think you need to file a flight plan unless your going a certain distance

[Luke]

I thought I read on here when this was originally discussed (the new helicopter purchased by the county that is) that they needed extra time to warm the bird up and file a flight plan. What is the point of a heads up if its only going to alert the flight crew that they might be needed? Pretty silly if you ask me. They should at least start the bird to be ready to go, no? Otherwise, how long does it take the crew to walk over to the chopper from inside?

[fire2li]

thats what they do, start it to warm up and wait for the go ahead

[enfdphoto]

A few weeks ago we had aviation swing by our hq to discuss the new bird.

Technically when the bird is put on stand-by they are doing everything but taking off. The flight crew removes the bird from the hanger, does their pre-flight checks and starts the bird and waits. In talking to the pilots they said when they first got the new bird there time was around 8 minutes but as they go more often they gotten down to 6-7 minutes.