# Any speculation regarding what will come of this?



## rmellish (Feb 4, 2009)

http://www.jems.com/news_and_articles/news/09/ems_public_hearing_announcement.html

I'm sure it will eventually lead to more regulations, but I don't have any first hand experience with HEMS.


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## VentMedic (Feb 4, 2009)

Read these links for a better understanding of what has led up to this point.

http://www.ntsb.gov/Publictn/2006/SIR0601.pdf

http://www.ntsb.gov/Recs/mostwanted/FedMWLPPTwebFINAL.pdf

Here is an overview of day 1:

http://www.verticalmag.com/control/news/templates/?a=9875&z=6

*Web Exclusive: NTSB Hearings on HEMS - Day 1 Report*
Tuesday, February 03, 2009 / Elan Head, Vertical Magazine​




> Washington, D.C., Feb. 3—In the first day of National Transportation Safety Board hearings on helicopter emergency medical services, the Board of Inquiry addressed key issues related to HEMS operations in the United States, including how those programs are structured, how operators are reimbursed, and whether competition in a largely deregulated HEMS industry has had a detrimental impact on safety.
> 
> Questions about the appropriate roles of competition and regulation in the HEMS industry will be recurring themes over the four-day hearings, as the Board of Inquiry grapples with the sector’s discouraging accident record. In 2008, 13 HEMS accidents claimed the lives of 29 people — more than in any calendar year to date.
> 
> ...


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## rmellish (Feb 4, 2009)

Thanks Vent. 

What do you see coming out of this?


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## Ridryder911 (Feb 4, 2009)

Personally, I see some restrictions but not as much as some would assume. The reason is simple ...$$$$$..... Helicopter owners and operators have a large amount of money invested within this type of services. I am sure they have great lobbyist and with many of their sponsors being hospitals, I would assume Hospital Lobbyist would be involved as well. 

Yes, a lot of flares and visible smoke... but when it clears, very little will be done. 

R/r 911


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## rmellish (Feb 4, 2009)

Do you think they'll make the night vision goggles a requirement for night scene landings?

That was one I had never thought about, but am now surprised that they aren't in widespread use, as the report suggests. They're SOP for military flight operations.


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## Veneficus (Feb 4, 2009)

nothing will come of this, it's nothing more than piss and wind to make it look like the issue is being taken seriously.

NVG and other toys are not the issue, the military has demonstrated quite well over the years all the things that can go wrong wth NVG.

The solution is simple. Bigger helos, Less helos, less usage of helos, and less money paid to operators. Best of luck getting that inacted.


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## rmellish (Feb 4, 2009)

Veneficus said:


> nothing will come of this, it's nothing more than piss and wind to make it look like the issue is being taken seriously.
> 
> NVG and other toys are not the issue, the military has demonstrated quite well over the years all the things that can go wrong wth NVG.
> 
> The solution is simple. Bigger helos, Less helos, less usage of helos, and less money paid to operators. Best of luck getting that inacted.



I'm aware that the NVGs aren't the key issue here. 

So a decrease in reimbursal amounts for HEMS operators is key in your opinion, since few regulations will be enacted?


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## Veneficus (Feb 4, 2009)

rmellish said:


> I'm aware that the NVGs aren't the key issue here.
> 
> So a decrease in reimbursal amounts for HEMS operators is key in your opinion, since few regulations will be enacted?



Call it power of the purse.

Ideally, there would be stricter criteria for calling a helo and certain amount of over triage would have to be accepted, but there should also be a post incident look on if it benefited the patient medically to refine the policies.

I also like the German idea of the government only giving a permit to operate a limited amount of helos in a certain area (usually 1 or 2) to prevent the oversaturation of them. Airmed has a valuable place, but the current system has led to too much abuse because of commercial interest.


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## rmellish (Feb 4, 2009)

Veneficus said:


> Call it power of the purse.
> Airmed has a valuable place, but the current system has led to too much abuse because of commercial interest.



I fully agree with you on that point.


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## Ridryder911 (Feb 4, 2009)

What most do not know (those that are in aviation medicine, probably will agree) is that HEMS and all other avaition medicine is one of most cut throat and shrewed medical business I have ever seen. 

We are not discussing ambulance in the 100K or billing for $500-1200 responses. We are discussing million(s) dollars of aircraft and charges thousands of dollars. If sponsored per hospital there is a reason. I can assure it is not because of the mercy that they have. It has to do with recruiting & transporting patients for speciality care to the mother ship hospital. The ICU/CCU, O.R. and hospital admission is the main goal. Again, we are discussing hundreds of thousands of dollars of potential payment income. 

I know of very few flight services that are not required to have a minimal PR time daily. The key chains, T-shirts, ensigna pins, ink pens, coffee mugs, etc. are not because you are so nice and a caring person. They are there to hopefully remind to whom to call and if it takes trinkets to get your interest.... that's a cheap deal. 

There is nothing wrong with HEMS. What is wrong is how it is handled. Where they are placed is usually not where they need to be. Anywhere that an EMS can return to a specialized facility within 30 minutes per ground, chances are air support is not needed. There is NO justification for it; in regards to amount of time saved. Not to describe the additonal dangers, costs, and increase support to provide a safe LZ and loading. 

In my area alone; we went from 3 helicopters in the 7 years ago to approximately 12 now and another one started yesterday. Ironically our state has remained the same size and in fact the traumatic injuries are actually down. Hmmmm...... 

As a flight nurse/paramedic I can attest that many times, flight was the best. I can also report many times, there would be no difference from flight or ground transport, other than the vehicle transporting the patient.... it just goes faster. 

In reality what many do not want to hear or confess is that there is little to no difference between air and ground transport (especially in care). The only reason most flight teams have more agressive protocols is due to their education and experience level. If ground EMS would provide the level of care, most HEMS would not be needed. 

R/r 911


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## vquintessence (Feb 4, 2009)

*Perhaps EMS contributed largely to the explosion air transports?*

Air seems to be relied upon/abused as well by us on the ground.  One company I work for in particular, which has a majority of its service area within towns and cities that are essentially large suburbs of Boston, most no more than 20 min transport times to the major hospitals.

I volunteer for an internal committee for CQI, and air transports among others ALL fall on our table.  That being said...

So, a typical transport time of 20 minutes, you'd assume we can handle much of the significant MOI, but yet every couple months we call for air transport (can't imagine how many we actually request) about as much as rural areas in western MA.  Interestingly enough, a handful of the same medics repeatedly make those air tx requests.  (Our EMT's are the best knowing when to scoop and screw, when they need ALS, and when ALS intercept is even practical).

A good number of pts don't require lengthy extrications, even more are compensating pts that can be handled with two medics in back and a FF or EMT driving.  Yet, air is called, and probably for no other reason than the attending "medic" wanting to pass the buck for being responsible treating the critical pt.  A good many units have waited for air intercepts LONGER than ground transport time.  Once a unit argued (over recorded lines) when air tx was unavailable, FURTHER increasing scene time.

People have been reprimanded and for a few it was a contributing factor to getting fired.  Air transport has become just like a crutch that the "medics" rely on when an pt is in true need of ALS.  Unfortunately it took money to get this situation noticed by the CEO's of this company, but at least something is happening.


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## rmellish (Feb 4, 2009)

Sometimes the expanded protocols of the HEMS is a factor when we consider requesting them. RSI is the first example that comes to mind. Not having an RSI protocol in a rural area leads to more calls for HEMS anecdotally.


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## VentMedic (Feb 4, 2009)

rmellish said:


> Sometimes the expanded protocols of the HEMS is a factor when we consider requesting them. RSI is the first example that comes to mind. Not having an RSI protocol in a rural area leads to more calls for HEMS anecdotally.


 
How do you manage the airway until the helicopter arrives?

What is the length of time for the helicopter to arrived after dispatched?


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## rmellish (Feb 4, 2009)

VentMedic said:


> How do you manage the airway until the helicopter arrives?


 
Same way we always do. I'm not a medic, but I know that our lack of RSI can be a consideration when we request a helicopter on scene, its never the primary reason though, or a least I've never heard it be the primary reason. That wouldn't make any sense.



VentMedic said:


> What is the length of time for the helicopter to arrived after dispatched?



10-15mins for the scenes I've been on where helicopters have been successfully requested.


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## VentMedic (Feb 4, 2009)

rmellish said:


> Same way we always do.


 
I'm sorry but I don't know what you have available. LMA? Combitube? King? BVM?

This is controversial amongst flight teams that are reluctant to pull an alternative airway which is doing an adequate job.  Even with RSI, there is not a guarantee of another successful airway short of a cric depending on the injuries. So, just the RSI factor is not always a valid argument for requesting a helicopter.


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## rmellish (Feb 4, 2009)

VentMedic said:


> I'm sorry but I don't know what you have available. LMA? Combitube? King? BVM?
> 
> This is controversial amongst flight teams that are reluctant to pull an alternative airway which is doing an adequate job.  Even with RSI, there is not a guarantee of another successful airway short of a cric depending on the injuries. So, just the RSI factor is not always a valid argument for requesting a helicopter.



Sorry, combitube or ET tube. You're right, its a piss-poor argument for HEMS.


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## VentMedic (Feb 4, 2009)

So many in EMS complain about ambulances or ALS units being overused and abused for what they perceive as nonemergent calls but yet, some of those complaining will be the first to yell for a helicopter. There may be one helicopter covering several hundred or more square miles which may get tied up with a patient that will be discharged from the ED before the helicopter lands back at its base. If you think an ambulance is an expensive taxi, you should see the price tag of a helicopter and the bill from it. 

Each area that utilizes a helicopter should have some sort of criteria to follow for activation. There should be a review periodically to see if it is more of a training/education issue with the ground crews than the patient.

EDIT:
Statements are made in general and not directed at remellish.


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## VentMedic (Feb 4, 2009)

Here's another article that puts a human touch to the need for some regulations, at least for night flights.

http://www.ems1.com/ems-advocacy/ar...in-Ind-copter-crash-drives-push-for-new-rules

*Daughter's death in Ind. copter crash drives push for new rules*

*By Jon Hilkevitch
Chicago Tribune *



> WASHINGTON — Robert Blockinger drives ambulances for a living, and although he was worried about his ill daughter, it never crossed his mind that she would die while being transported from one hospital to another.
> 
> Kirstin Blockinger was on the second air-ambulance flight of her 14-month life last fall when the helicopter taking her to a Chicago medical facility crashed in west suburban Aurora, Robert and his wife, Brooke, said Tuesday in their first interview.
> 
> "I am very much into the emergency scene, and it has become quite obvious -- painfully obvious to my wife and I -- that there needs to be changes," said Robert Blockinger, 24, a military medic specialist who served in Iraq with the Illinois National Guard. Back home, he drives ambulances for a private company, has been a firefighter in his rural Illinois community of Leland since 2000 and plans to begin classes to become a certified paramedic, he said.


 
Sidenote: This is a serious and touching article.  I really would like some to refrain from criticizing the author or the father, who lost his child in a crash, for making the statement "drives ambulances for a living".   This is not the issue being addressed here.


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## ffemt8978 (Feb 5, 2009)

Hmmm....Considering in my area it is an hour by ground to a hospital, or 25 minutes by helo...guess which ride my critical patients are going to get.


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## javajunkie (Feb 7, 2009)

Well said R/r!  I would like to add that HEMS operations are also well-known in the aviation industry as the most cut-throat and dirty-politics group of people, more so even than skydiving operations (which were also targeted by the NTSB last year).


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