# Medivac



## firecoins (Apr 1, 2007)

Got to dispatched to the ER to assist transfer a patient into a local medivac helicopter.  That was weird for me at least.  MY new corp this is a usual call because the hospital is in our area. My old one used the same hospital but it was not in our area.  The ER called 911. 

We tranferred a toddler having seizures for over an hour from a level 2 trauma to a chopper going to a level 1.


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## Ridryder911 (Apr 1, 2007)

Why?... Level II is the same except residency programs... Must have been a Level I pediatric center. Also, as well .....seizures is not trauma (unless induced by such). 

R/r 911


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## firecoins (Apr 1, 2007)

I don't know exactly.  I wouldn't trust the hospital we were picking up from anyway. I would much rather be at the hospital we sent the patient too than the pick up.

I suspect the reason is that the receiving hospital is alot more facilities.  Its a teaching hospital with more staff in house 24/7. The transfering hospital has a pediatric E.R. which means they should be able to handle it. But as I said the receiving hospital is head and shoulders a better facility.


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## Flight-LP (Apr 1, 2007)

How far apart are the two hospitals? Was the toddler intubated? Sorry, curiosity is getting the better of me this morning............................


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## firecoins (Apr 1, 2007)

yes the toddler was intubated.  The flight crew brought in 3 bags with them. One contained a mini resperator. 

The hospitals were about a 20 minute drive from one another.  Nyack hospital in Nyack to Westchester hospital in White Plains. Its a 2 or 3 minute flight.


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## yowzer (Apr 1, 2007)

firecoins said:


> The hospitals were about a 20 minute drive from one another.  Nyack hospital in Nyack to Westchester hospital in White Plains. Its a 2 or 3 minute flight.



They flew a 20 minute ground transport instead of sending by CCT ambulance? Wow. 

For that matter, a level II located that close to a level I? Wow.


Other places are strange and scary. I don't like them. :unsure:


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## Emtgirl21 (Apr 1, 2007)

We have two level II trauma centers less than a mile apart.


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## firecoins (Apr 1, 2007)

Nyack Hospital is a level 2. It has a cancer center and a pediatric ER during the day time but no cardiac unit. 

20 minutes West along the New York State thruway is Good Sam, another level 2 ER. It has a very new cardiac unit that only does angioplasties. 

Nyack and Good Sam are the ususal hospitals we take patients to.  

About 20 minutes South of us is Englewood Hospital, a NJ hospital with a full cardiac unit.  I don't know much about their ER.  

Also about 20 minutes South from us is Pascack Valley Hospital. I am not sure about their ER but they also have a full cardiac. 

We can go to Englewood or Pascack but it rarely happens.

Westchester Medical Center is about 20 minutes East of us.  They run the medivac system.  Nyack decided to airlif because they are the only ambulance service with critical care setup available which is above the available ALS service via ground. Sometimes we transport here via ground if there is bad weather and the chopper can't fly.


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## Jon (Apr 1, 2007)

That is kind of odd... around here, many hospitals run Critical Care Units for ground retrivials. Childrens Hospital Of Philly uses RNs and CRNPs on theirs.

How far was the drive from the ED to the helicopter LZ?

Was it a fixed landing pad, or an LZ in a field?


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## firecoins (Apr 1, 2007)

Nyack does not have a landing pad. The chopper was landed by the FD in a sports field directly across the street from the ER.  It was about 150 yards from the ER.  Pretty close.  A couple of nurses walked to the LZ faster than we drove across to the helicopter with the patient.  

Calling Stat Flight for Critical Care is pretty standard here.


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## akflightmedic (Apr 1, 2007)

Wow, pretty amazing that they would put that many people at risk and spend that much money for a 3 min flight!!

I dont get it but hey thats me.

Anyways, in your area is it common for the flight crew to just jump in back with their equipment and let you drive them? Is that an option there?

I could never see any of the flight programs I work for going through all the expense and life risk for a 3 min flight no matter how much money can be billed.


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## Epi-do (Apr 1, 2007)

Emtgirl21 said:


> We have two level II trauma centers less than a mile apart.



I can beat that!  We have 3 level I trauma centers in downtown Indy.  One of them is a pediatric hospital, and is literally across the street from the second level I.  The third level I is about 1 mile away from the first two.


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## firecoins (Apr 1, 2007)

akflightmedic said:


> Wow, pretty amazing that they would put that many people at risk and spend that much money for a 3 min flight!!
> 
> I dont get it but hey thats me.
> 
> ...



I assume your a flight medic.  Getting the flight crew in our rig was pretty safe. And going street and back with the patient is standard since Nyack has no helicopter pad.  I am told this happens everytime Nyack medivacs someone to Westchester. The chopper was turned off before the crew exited and turned on after everyone was clear. THe dangerous part to me was landing on the dark field. Everything else seemed safe.

Its quite common to call in Stat flight to the scenes of MVAs where the patient is already in an ambulance waiting for them. The flight crew usually exits the helicopter and comes into the rig to prepare the patient for flight.


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## Jon (Apr 1, 2007)

firecoins said:


> I assume your a flight medic.  Getting the flight crew in our rig was pretty safe. And going street and back with the patient is standard since Nyack has no helicopter pad.  I am told this happens everytime Nyack medivacs someone to Westchester. The chopper was turned off before the crew exited and turned on after everyone was clear. THe dangerous part to me was landing on the dark field. Everything else seemed safe.
> 
> Its quite common to call in Stat flight to the scenes of MVAs where the patient is already in an ambulance waiting for them. The flight crew usually exits the helicopter and comes into the rig to prepare the patient for flight.


Firecoins.... I think akflightmedic was questioning the sanity of the flight program for using a helicopter for a run that would be handled by ground in many places.

He wasn't looking at the safety of the ground transfer, but the safety of the helicopter flight. Remeber... Air Ambulances fight Gravity... when Gravity wins, it's a bad day for EVERYONE.


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## yowzer (Apr 2, 2007)

> Assorted trauma center boastings



Washington has one level I trauma center (Serving Washington, Alaska, Idaho, and Montana). A handful of IIs, and a bunch of III, IV and even V. There are only 2 out of 9 hospitals in Seattle with official trauma ratings - Harborview, the I, and Northwest, a IV (Well... the University of Washington and Children's hospitals are level I rehab). Hence my bemusement at cities back east that seem to have Is and IIs on every corner. It's like they're Starbucks or something.  

There's a fair number of critical care ambulances (EMT + RN) in the greater Seattle area -- it's very rare to fly a emergent interfacility transport that's under 40-50 miles if any of the ground units are available nearby. For longer trips, with BLS and stable CCT patients (No private medics in my area. Someone goes with a ECG or running drugs, they get a nurse)... I've driven 200+ miles with a patient, and also met folks flown the same distance by fixed-wing that walk off the plane to our ambulance.

I'm not sure what's safer: A 5 minute flight with short ambulance rides on each end or (very common occurrence) 30+ miles of driving priority down a major interstate like I did the other day. Probably the copter, though in this particular case it would have been kind of hard to put a balloon pump in one. Those suckers are heavy! Not to mention the perfusionist running it...

--

When we meet incoming airlifts, the flight crew usually rides with us to the hospital with the patient, unless it's a complete BS BLS trip.


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## Guardian (Apr 2, 2007)

akflightmedic said:


> Wow, pretty amazing that they would put that many people at risk and spend that much money for a 3 min flight!!
> 
> I dont get it but hey thats me.
> 
> ...



someone recently told me a private medical transport helicopter charged them 12K for transport.  Is this possible?


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## Ridryder911 (Apr 2, 2007)

Want to know why there are going to be an end to flight services? 

Hmm let's review: 

Possible danger of flight crew... yes, every time their in the the bird it is dangerous!..Remember, landing is a controlled crash. Trust, me I have been a flight nurse/medic too long to know better. 

Hmmm ... >$10,000 for a 6 minute drive. Wow! .. Figure that they really did not save anytime .. since it takes at least 2-5 minutes for start up and braking the blades.. etc. 

Abuse of the system: Sorry, any Level II should had been able to stabilize even a pediatric or even neonate enough for a ground transport unit.  Especially so close. I can assure you if the hospital was responsible for the bill, this process would immediately stop. 

There has been research demonstrating there is no significant justification to "fly" neonate teams. Even adult trauma and medical problems is debatable to say the least unless it is in remote areas or long distance >40 minutes. More we disclose the myth of the "Golden Hour", we will see more problems of EMS helicopter services justify their existence.

Now, in about five to ten years when these air programs are no longer there, we will know why. 

R/r 911


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## firecoins (Apr 2, 2007)

Jon said:


> Firecoins.... IHe wasn't looking at the safety of the ground transfer, but the safety of the helicopter flight. Remeber... Air Ambulances fight Gravity... when Gravity wins, it's a bad day for EVERYONE.



yes I understand that.  Actually I think the flight is safer than most ground ambulances.   

As for the short distance, I don't think the kid needed a helicopter.  The family was Hasidic Jews and the call was on Shabbas.  Stat Flight may have been called on acccount of that.


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## Jon (Apr 2, 2007)

firecoins said:


> yes I understand that. Actually I think the flight is safer than most ground ambulances.
> 
> As for the short distance, I don't think the kid needed a helicopter. The family was Hasidic Jews and the call was on Shabbas. Stat Flight may have been called on acccount of that.


 
Wow... thats a B.S. excuse. (I'm not directing this at you, FireCoins).

Judiasim allows "flexability" of all of the strick rules "to save a life" - that's why jewish MD's will come in to deliver babies on Shabbat... and why Ambulance Service dosen't stop in Israel on every Saturday.


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## Jon (Apr 2, 2007)

Ridryder911 said:


> Want to know why there are going to be an end to flight services?
> 
> Hmm let's review:
> 
> ...


Ok Rid.

Around here, CHOP's transport team does ground transport for almost anything within about 50 miles. They WILL do aeromedical retrivial in some select situations, but it is rare (They 'borrow' someone else's bird and put thier crew in it).

Jefferson used to drive out 50+ miles for pickups, as did Temple (Two big Level 1 TC's, Teaching hospitals, with compeating transport teams), Both of them now have thier own Aeromedical units, and will often turf an extended-distance run to thier own helicopter, as it gets the patient to the hospital faster, and doesn't tie up the ground CCT crew for 2+ hours with one patient.

I agree that a flight as short as that is probably not worth the risk... to both patient and crew... of the aeromedical transfer.


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## firecoins (Apr 2, 2007)

I am Jewish so I am not implying anything negative.  Basically the religious reason to save life ups the intensity factor.  

The medivac was probably called in because:
1. It was an emergency involving a child.  
2. The deeply religious community puts a high value on life. Not that we don't but the whole community will come to help one person.  We are talking thousands of people.  This is why I mention the intensity issue.
3. I believe its SOP but am not certain


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## BossyCow (Apr 2, 2007)

yowzer said:


> .. I've driven 200+ miles with a patient, and also met folks flown the same distance by fixed-wing that walk off the plane to our ambulance.......When we meet incoming airlifts, the flight crew usually rides with us to the hospital with the patient, unless it's a complete BS BLS trip.



You must meet and greet some of my patients!


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## fm_emt (Apr 3, 2007)

I've seen Stanford LifeFlight come to one of our hospitals to pick a patient before. Stanford University Hospital was 17.2 miles away.
It's possible that the CCT rigs were all out of the area, though. Last time I saw this happen was on a busy St. Patrick's Day.


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## yowzer (Apr 3, 2007)

BossyCow said:


> You must meet and greet some of my patients!



Probably not. Most of those transports are to the east or south: Places like Spokane, Walla Walla, or Portland. 

Aside from the occasional Bremerton or Port Angeles pickup, we don't get out to the peninsula very often.


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## firecoins (Apr 3, 2007)

Walla Walla? Is related to Ho Hokus, NJ?


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