Maryland begins replacement of Med-Evac helicopters

[usalsfyre]

The 2nd biggest issue causing the detriment to our industry, behind failure to comply with appropriate safety recommendations from the NTSB.

We have to educate our frontline responders on when it is appropriate to utilize us. In addition, they have to stop getting their feelings hurt and their panties in a wad when we say something is not appropriate. For those not appropriately triaging due to lack of understanding or fear, they should take it as an educational offering to improve their abilities. For those being too lazy to appropriately deliver care to their patients, they should take it as a wake up call to stop being a lazy provider. It is really as simple as that. For the protection of my life and that of my co-workers, this topic cannot be sugar coated. Any true professional out there can see this reality.................................

One of the biggest takeaway points from my limited time in air medical was this: I don't wanna be the guy that kills a flight crew calling for something stupid.

 

[usafmedic45]

Guess I really wasn't thinking of trauma (although since that's all MSP flies I should have) and was more thinking about difficult IFTs. From personal experience there's all sorts of stuff that just doesn't belong in a 206/407 platform.

Honestly, if they are that critical, the crew should do those procedures before leaving or go by fixed wing.

Also list in ours, but is violated every day by medics who are to dumb/scared/lazy to change their practice.

Then your medical director needs to let his balls drop and punish them. I fired a couple and suspended more people than I can easily count for violating our protocols on aeromedical transport. It was the most common reason for a suspension actually.

We have to educate our frontline responders on when it is appropriate to utilize us

Then we need to stop letting operations like Air Evac Lifeteam send out their PR girls to bribe EMS personnel with pizza, soda, t-shirts and buttons.

 

[Flight-LP]

Then we need to stop letting operations like Air Evac Lifeteam send out their PR girls to bribe EMS personnel with pizza, soda, t-shirts and buttons.

And how do you suggest WE do that? Is there some mythical control out there that I am not aware of? The NTSB has made countless recommendations. Until the FAA MANDATES them or the State powers that be get involved, it will remain voluntary. With the money these private for profit organizations are shoving to the PAC's, good luck getting past the red tape.

I agree that change needs to take place, but perhaps an alternate approach would be for us medics and nurses taking a stance and avoiding the entities that are challenged in the realm of safe and appropriate operations. It's a nice thought in theory, but the power of the golden flightsuit is too tempting for the star struck blinded view of some medics. I would like to be hopeful, but I am also quite realistic. I know that I go into work every shift maintaning a strong safety culture and assertiveness to avoid hazardous attitudes and potentially known hazardous situations. I am fortunate to be surrounded by co-workers who agree and maintain a similar stance. We have and will continue to decline missions if a crewmember has a belief of an unsafe situation. We enjoy the support of management who allow and support this without punitive recourse.

Personally, our rotor operations are fortunate in the fact that we support a military client. Uniformity and strict clear adherence to established utilization policies are not an issue. Too bad other EMS entities can't enforce standards like the military can!

Fly safe my friend!

 

[usafmedic45]

And how do you suggest WE do that? Is there some mythical control out there that I am not aware of? The NTSB has made countless recommendations. Until the FAA MANDATES them or the State powers that be get involved, it will remain voluntary. With the money these private for profit organizations are shoving to the PAC's, good luck getting past the red tape.

I have no good answer for that. I figure it's just going to take them (as in the private companies, of which AEL has the worst safety record of any HEMS operation out there; I can hear the printers at their PR office warming up now to send me more nasty letters for bringing that up....haven't gotten one in a while...) having another "bad year" and the FAA will really come down hard on them. There are some major changes in the works from the FAA end, but the industry has not seen anything yet if things do not improve dramatically.

We have and will continue to decline missions if a crewmember has a belief of an unsafe situation. We enjoy the support of management who allow and support this without punitive recourse.

I like the organization I fly for. Our chief pilot is our CEO and founder so he knows the flight operations side of things and he is a PA so he knows the medical side of the equation as well. I scrubbed a mission a while back because I had been watching the weather develop all night and I called him and told him it was a "no go" on my part. He said I was being a little overly cautious but that was OK. The dire weather prediction I had made (much worst even than what was formally forecast) came true about three hours later which is about the time we would have been heading right into it. He told me that if I ever don't feel right about a mission again to speak up because he would "much rather scrub the flight than have to be scrubbed off of the flight".

 

[JJR512]

It still would not improve outcomes in trauma because calling for the helicopter is going to inherently delay access to definitive care which is far detrimental than anything you can easily and reliably do in a helicopter.

In Maryland, the Trooper (Maryland State Police Medevac) isn't supposed to be called for unless it will get the patient to the appropriate facility quicker than by ground. Taking into account how long it will take the Trooper to arrive, then transport, vs. immediate ground transport.

For example, in Howard County, Troopers are rarely called for anymore. Since Trooper 2 crashed, and Trooper 8 was shut down in the aftermath, the nearest one is about 20 minutes out. But Howard County is a suburb county of Baltimore; we're to Baltimore's southwest. And Shock Trauma is in the southwest corner of Baltimore. From most placed in Howard County, ground units can get to Shock Trauma in 30 minutes or less. So, 20 minutes for the Trooper to arrive, a few minutes for them to do their thing and load, then a few minutes to Shock Trauma? Most providers in the county know it's not worth it. Now, if it's going to be a lengthy extrication, they'll call for one, because chances are the Trooper will get on scene before the patient is out. In that case, it's only a few minutes flight to Shock Trauma vs. still 15-30 minutes by ground.

Now, does it ever happen that a Trooper is called for when ground transport would have been faster? I'm sure it does. But I don't see that calling for a helicopter will inherently delay access to definitive care, not to the point where a blanket statement like that can be made. Sometimes, maybe. But I would venture to say not usually.

Guess I really wasn't thinking of trauma (although since that's all MSP flies I should have)...

Just for the record, this statement is incorrect. MSP also does hospital transfers for pediatrics. I've seen it happen, and was given to understand that it's not uncommon.

 

[usafmedic45]

In Maryland, the Trooper (Maryland State Police Medevac) isn't supposed to be called for unless it will get the patient to the appropriate facility quicker than by ground. Taking into account how long it will take the Trooper to arrive, then transport, vs. immediate ground transport.

For example, in Howard County, Troopers are rarely called for anymore. Since Trooper 2 crashed, and Trooper 8 was shut down in the aftermath, the nearest one is about 20 minutes out. But Howard County is a suburb county of Baltimore; we're to Baltimore's southwest. And Shock Trauma is in the southwest corner of Baltimore. From most placed in Howard County, ground units can get to Shock Trauma in 30 minutes or less. So, 20 minutes for the Trooper to arrive, a few minutes for them to do their thing and load, then a few minutes to Shock Trauma? Most providers in the county know it's not worth it. Now, if it's going to be a lengthy extrication, they'll call for one, because chances are the Trooper will get on scene before the patient is out. In that case, it's only a few minutes flight to Shock Trauma vs. still 15-30 minutes by ground.

I used to run with PG County. I know the geography and the standards out there pretty well. The problem with assuming that it's "a few minutes flight to Shock Trauma" (which is not an America College of Surgeons Committee on Trauma accredited trauma center by the way; they won't even let the inspectors into the facility out of hubris. http://www.facs.org/trauma/verified.html ) is that it leaves out the scene interval, etc that negates the "speed" advantage that people often cite when advocating the use of helicopters. That and give a lack of hard data on the subject, we don't really know if the new "regulations" have changed anything or if it is still "it puts the patient in the helicopter or else it gets the hose again" like it was before Trooper 2 crashed. However, the best predictor of future behavior is past behavior and people in other states use Maryland as an example of how not to run an EMS system all the time so what does that tell you?

Because Dr. Bass doesn't want to look foolish or because he really thinks he is beyond reproach (or a combination of the two), he simply refuses to make public the actual data, but still claims that they have "evidence" that the MSP Aviation operations improve trauma care. It's a lot like someone claiming that they know there is a God, but not having any evidence to back up their claim. The burden of proof is on the person making the extraordinary claim and given that every other source of reliable HEMS data in an urban and suburban environment (and Maryland with the exception of the extreme western end and maybe a little of the Eastern Shore and a small chunk of southern Maryland is an urban and suburban environment) shows no appreciable benefit or even a slight negative effect on outcomes, Dr. Bass is more akin to the crazy guy on the corner preaching to traffic than a medical expert.

 

[usafmedic45]

MSP also does hospital transfers for pediatrics.

We also used to use them to do adult transfers between Andrews AFB's hospital and Bethesda Naval and WRAMC. I was actually on a flight where we were supposed to go to Bethesda and the MSP pilot landed us at WRAMC.

 

[MrBrown]

Those helicopters look super awesome and get the Orange Jumpsuit seal of approval, however, HEMS operations generally do not.

Captain Brown (CPL MEL ATPL(t)) says to improve safety HEMS needs to be regulated dual pilot and IFR where possible under FAR Part 121 ....

 

[Aidey]

...(which is not an America College of Surgeons Committee on Trauma accredited trauma center by the way; they won't even let the inspectors into the facility out of hubris. http://www.facs.org/trauma/verified.html )

Not to hijack the thread, but is there another agency that issues trauma accreditation? I noticed several hospitals from Kansas City, MO missing and the state of Washington wasn't even on the list.

 

[Flight-LP]

Those helicopters look super awesome and get the Orange Jumpsuit seal of approval, however, HEMS operations generally do not.

Captain Brown (CPL MEL ATPL(t)) says to improve safety HEMS needs to be regulated dual pilot and IFR where possible under FAR Part 121 ....

While I agree with your content, unfortunately EMS ops fall under Part 135, not 121. If we had to adhere to 121 standards, this whole topic would be a moot point as we wouldn't have 1/2 the issues we currently face.

 

[Flight-LP]

MSP also does hospital transfers for pediatrics. I've seen it happen, and was given to understand that it's not uncommon.

Poor children! Do they not deserve a better quality of care than a single Paramedic with minimal training?

Some specialty populations deserve a dedicated specialty team (i.e pediatrics, neonates, HROB).

 

[usalsfyre]

Those helicopters look super awesome and get the Orange Jumpsuit seal of approval, however, HEMS operations generally do not.

Captain Brown (CPL MEL ATPL(t)) says to improve safety HEMS needs to be regulated dual pilot and IFR where possible under FAR Part 121 ....

The problem is they don't fit particularly well under 121 either. What's really needed is a new FAR section covering all medical evacuation flights, including fixed wing.

 

[JJR512]

Poor children! Do they not deserve a better quality of care than a single Paramedic with minimal training?

Some specialty populations deserve a dedicated specialty team (i.e pediatrics, neonates, HROB).

When MSP does a pediatric transfer, they first go to UMMC and pick up a pediatrics critical care nurse. That is actually how I came to know this fact. I used to work for Maryland Express Care, the critical care ambulance service for UMMC. One day, I was asked by one of our pediatric critical care nurses to help carry her bags up to the landing pad atop Shock Trauma, because she was getting picked up for a transfer run.

To answer the question I'm sure is coming next, I don't know why pediatric transfers are delayed by the extra step of picking up a nurse at one hospital before going to the patient, rather than just sending a private helicopter directly there. In fact, MEC has its own helicopter. Perhaps MSP just serves as a backup, and MEC's helicopter was otherwise engaged at the time. Or perhaps they want a pediatric specialist nurse and MEC's own helicopter and the other privates don't have one available. I don't know.

 

[usalsfyre]

When MSP does a pediatric transfer, they first go to UMMC and pick up a pediatrics critical care nurse. That is actually how I came to know this fact. I used to work for Maryland Express Care, the critical care ambulance service for UMMC. One day, I was asked by one of our pediatric critical care nurses to help carry her bags up to the landing pad atop Shock Trauma, because she was getting picked up for a transfer run.

To answer the question I'm sure is coming next, I don't know why pediatric transfers are delayed by the extra step of picking up a nurse at one hospital before going to the patient, rather than just sending a private helicopter directly there. In fact, MEC has its own helicopter. Perhaps MSP just serves as a backup, and MEC's helicopter was otherwise engaged at the time. Or perhaps they want a pediatric specialist nurse and MEC's own helicopter and the other privates don't have one available. I don't know.

So now we're using the same minimally trained paramedic and a nurse who is likely not familiar with the transport environment. Still not a good option.

 

[usalsfyre]

The problem is they don't fit particularly well under 121 either. What's really needed is a new FAR section covering all medical evacuation flights, including fixed wing.

Actually just thought of this, even if there was a specific FAR for medical flights, it's unlikely MSP would be covered as they're public use.

 

[usafmedic45]

Not to hijack the thread, but is there another agency that issues trauma accreditation? I noticed several hospitals from Kansas City, MO missing and the state of Washington wasn't even on the list.

States can also "accredit" hospitals in some instances, but a lot of people view that as suspect since it is often see it as a lesser standard. Given that Maryland and Shock Trauma like to tout themselves as setting some standard or leading the way, the fact that they are not taking part in what is viewed as the gold standard is somewhat suspect and good evidence that they are not willing to operate in a transparent manner.

Actually just thought of this, even if there was a specific FAR for medical flights, it's unlikely MSP would be covered as they're public use.

There will likely be a closure to that loophole quite soon since there was a major uproar in the aviation community when it came out recently that non-military government entity operations have an appalling crash rate.

Captain Brown (CPL MEL ATPL(t)) says to improve safety HEMS needs to be regulated dual pilot and IFR where possible under FAR Part 121 ....

FAR Part 121 is for scheduled commercial operations (read as: airlines and schedule air cargo (FedEx, UPS, etc)). You are thinking of Part 135 which covers on-demand commercial flights. It would be extremely difficult if not flat out impossible to meet the 121 standards in a time-sensitive setting. It's far more than just crew and equipment requirements.

this whole topic would be a moot point as we wouldn't have 1/2 the issues we currently face.

Because you'd see a 50+% reduction in flights because the paperwork wasn't done in time.

When MSP does a pediatric transfer, they first go to UMMC and pick up a pediatrics critical care nurse. That is actually how I came to know this fact. I used to work for Maryland Express Care, the critical care ambulance service for UMMC. One day, I was asked by one of our pediatric critical care nurses to help carry her bags up to the landing pad atop Shock Trauma, because she was getting picked up for a transfer run.

So they delay the transfer- which is supposed to be going by air because of a time savings- to go pick up extra personnel? That's so ludicrous if it wasn't well documented that MSP pulls this sort of crap on a regular basis, I'd call bull****.