Flight question

[usalsfyre]

OK. I just think there is no point in flying as glorified cargo if there's not a benefit to the patient.

I actually truly believe there is benefit when you consider the way the US EMS system is structured. I'm not sold on the transportation method so much as bringing high level providers to bedside. Unfortunately there is no mechanism to do that without an aircraft currently reimbursement wise.

 

[usafmedic45]

I'm not sold on the transportation method so much as bringing high level providers to bedside. Unfortunately there is no mechanism to do that without an aircraft currently reimbursement wise.

Then why are we not seeing impacts on outcomes either way? I think that idea is simply what the HEMS companies throw out there when you start demanding proof they are doing something other than profit mongering.

 

[usalsfyre]

Then why are we not seeing impacts on outcomes either way? I think that idea is simply what the HEMS companies throw out there when you start demanding proof they are doing something other than profit mongering.

My guess? The places doing the research tend to put high level providers at bedside anyway. Plus your not getting a high enough volume out of Joe-Bubbas towing, auto repair and EMS to really skew the results.

 

[usafmedic45]

My guess? The places doing the research tend to put high level providers at bedside anyway. Plus your not getting a high enough volume out of Joe-Bubbas towing, auto repair and EMS to really skew the results.

Well, even when they do look at rural environments there is no significant impact. You don't need high volume of subjects to have statistical significance.

 

[usalsfyre]

Well, even when they do look at rural environments there is no significant impact. You don't need high volume of subjects to have statistical significance.

Refresh my memory, trauma outcomes or overall outcomes? It's been close to six months since I've really looked at air medical outcome data.

 

[Flightorbust]

that surprises me that in a rural environment there's no gain considering the level of care is increased while the transport time is decreased.

 

[usalsfyre]

The reason I ask is...I only see putting those providers at bedside being helpful in a relatively small subset of patients. Even a badly injured, but otherwise simple to manage trauma patient won't benefit. The categories I see it helping are

1)Patients requiring pharmacologically-facilitated airway management.

2)Patients who require complex hemodynamic management (ROSC, cardiogenic shock)

3)Patients with respiratory failure from disease states that create difficulties in ventilation. (poorly compliant lungs, ect)

Outside of those and maybe a few other situations, I don't see advanced providers making a huge difference. Of course the is 100% opinion, and obviously we're massively over saturated if that's the case.

 

[usafmedic45]

the level of care is increased

Have you ever tried to work in the back of a helicopter? You're not doing a whole heck of a lot while in transit which.....

while the transport time is decreased.

...explains why you are mistaken until you get into really long distance transports (>100 miles). Most of the time going by ground is quicker because you don't have all the lag time associated with flight operations and you can do most things en route rather than having to do them prior to loading the patient.

 

[usafmedic45]

1)Patients requiring pharmacologically-facilitated airway management.

Most of those are dead or already Schiavo-esque by the time the bird arrives.

3)Patients with respiratory failure from disease states that create difficulties in ventilation. (poorly compliant lungs, ect)

Then you're better off using a fixed-wing where you can carry a more complex ventilator than the Para-Pac, LTV or T-Bird you find on most HEMS operators. None of those are very good in non-compliant lungs.

Patients who require complex hemodynamic management (ROSC, cardiogenic shock)

As opposed to having the ability to carry more pumps on a ground ambulance? For the purposes of determining what to use, telemedicine is a much more time and cost-effective measure. You don't need a crew of three (well, two and a pilot) to handle a patient who is ROSC or in cardiogenic shock. A competent ICU nurse, a ground ambulance crew and a driver with a lead foot is sufficient. Not to mention if you want to take along an ECMO or IABP, it's a lot simpler to do so during a ground transport.

 

[Flightorbust]

...explains why you are mistaken until you get into really long distance transports (>100 miles). Most of the time going by ground is quicker because you don't have all the lag time associated with flight operations and you can do most things en route rather than having to do them prior to loading the patient.

Here we have alot of national forest and some areas that would require 100+ mile transport

 

[usalsfyre]

Most of those are dead or already Schiavo-esque by the time the bird arrives.



Then you're better off using a fixed-wing where you can carry a more complex ventilator than the Para-Pac, LTV or T-Bird you find on most HEMS operators. None of those are very good in non-compliant lungs.



As opposed to having the ability to carry more pumps on a ground ambulance? For the purposes of determining what to use, telemedicine is a much more time and cost-effective measure. You don't need a crew of three (well, two and a pilot) to handle a patient who is ROSC or in cardiogenic shock. A competent ICU nurse, a ground ambulance crew and a driver with a lead foot is sufficient. Not to mention if you want to take along an ECMO or IABP, it's a lot simpler to do so during a ground transport.

I agree with every point you make actually. Like I said though, right now it's a reimbursement issue. Ideally you could take the money spent on HEMS and use it redistribute it towards better ground programs.