the 100% directionless thread

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Chewy20 said:
do you mean auto-injector?
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Negative. Some areas can give IV Epi. My internship county can give .1mg IVP of 1:10,000 and repeat up to a max of .5mg.
 
STXmedic said:
@TransportJockey When I was looking for a picture to change my profile pic too, I was fully intending on using the caffeine chemical structure. When I went to save it, I realized it looked very familiar... Jerk... Lol
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Lol I have had it for a bit. I almost went with epi, since that's what is on my wrist lol
 
disregard
 
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I like cheese
 
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Ours is 0.3mg 1:1000 IVP in patients "near cardiac arrest". Standing order.
 
We can give 0.3 1:10,000 IVP for "impending circulatory collapse" or severe respiratory distress refractory to IM injection.
 
OK - I'm confused. Are there some typos going on around here or are there really systems that use undiluted epi 1:1000 as an IV medication?
 
New idea: A course in basic statistics and possibly logic should be required for graduation from high school.

In long conversations with certain local BLS personnel I have been unable to impress upon them the reality that air transport is statistically significantly more dangerous than transport by ground. Showing numbers means nothing, since "in this county, we've had way more ambulance accidents and people have DIED."

The terms anecdotal evidence or confirmation bias mean nothing to some people. The other day, I quipped that the "plural of anecdote is not data" and I was told of course it is. Sigh. I guess there's just certain things I can't understand since I'm not from here...[emoji19]
 
chaz90 said:
New idea: A course in basic statistics and possibly logic should be required for graduation from high school.

In long conversations with certain local BLS personnel I have been unable to impress upon them the reality that air transport is statistically significantly more dangerous than transport by ground. Showing numbers means nothing, since "in this county, we've had way more ambulance accidents and people have DIED."

The terms anecdotal evidence or confirmation bias mean nothing to some people. The other day, I quipped that the "plural of anecdote is not data" and I was told of course it is. Sigh. I guess there's just certain things I can't understand since I'm not from here...[emoji19]
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Do you have a source for that? I haven't looked at any analyses on this stuff in quite a while.

Remember that you can't compare accidents/miles flown to accidents/miles driven - which many commenters try to do - if you are going to assume that the alternative to HEMS is a L&S run to the trauma center.

Also you have to factor in that the vast majority of HEMS crashes happen at night and in unfavorable meteorological conditions; in daylight and good weather I wouldn't be surprised if it's actually safer to fly than to drive L&S.
 
Remi said:
Do you have a source for that? I haven't looked at any analyses on this stuff in quite a while.

Remember that you can't compare accidents/miles flown to accidents/miles driven - which many commenters try to do - if you are going to assume that the alternative to HEMS is a L&S run to the trauma center.

Also you have to factor in that the vast majority of HEMS crashes happen at night and in unfavorable meteorological conditions; in daylight and good weather I wouldn't be surprised if it's actually safer to fly than to drive L&S.
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Working on finding additional studies, but these are a couple I found off the bat. It is difficult to compare statistics between both situations directly. You're absolutely right that the majority of HEMS accidents occur at night or during adverse weather, but I think it's only fair to continue to factor those in just as they are for ground EMS transport. I'd also agree that there is a significant danger associated with a L&S transport, particularly if the driver is excited or inexperienced. Just another issue we continue to attempt to fix. In many of the cases I discuss with local BLS, ALS on scene doesn't want to transport emergently, let alone utilize a helicopter for patients we have triaged as having minor or moderate, likely non time sensitive, injuries.

http://www.ncbi.nlm.nih.gov/m/pubmed/22195397/?i=6&from=/15651942/related

http://www.ncbi.nlm.nih.gov/m/pubmed/15211144/


I think US HEMS has done an admirable, though incomplete, job of improving safety over the last 25 years. As the number of programs, flights, and flight hours have drastically increased, accidents have decreased drastically over most years on an incident/flight hour rate. The problem lies in the fact that while the actual accident rate is likely lower than in ground EMS, the serious injury or fatality rate is higher. Still working on finding where I read this, but don't roughly 40% of HEMS accidents involve at least one fatality? Perhaps a comparison of the fatal injury rate would be more fair.
 
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If you are going to compare apples to apples, then I think you can only compare miles flown (or HEMS transports completed) to miles driven (or ground transports completed) emergently. There's just not a reasonable parallel between the millions of miles of medical facility --> back to the nursing home transports and the rollover with ejection --> trauma center transports. And I think once you do that, you'd probably find that flying is not less safe, and is perhaps even more safe.

Look into the stuff written by Dr. Ira Blumen. He's an EM physician from Chicago who has been involved of lots of detailed analysis of HEMS industry efficacy and safety. Overall he's very critical but he's also fair and his opinions are very fact-based.

The HEMS industry has a lot of room for improvement. I'm highly critical of what goes on in many parts of the industry but I also very firmly believe that a properly designed and utilized HEMS system is a very valuable and appropriate resource in many (certainly not all) areas. There's also the argument that a single HEMS unit can replace numerous ground CCT units over a large geographical area, making a helicopter actually more cost-effective than ground CCT units; that analysis came out of a study done in one the areas I used to fly.

Most of the problems in HEMS, IMO, are either directly or indirectly related to the dramatic overuse that has resulted largely from the proliferation over the past 15 years of "community-based programs". What has happened in HEMS since the mid-90's is like what would happen if a commercial ALS service set up an ambulance base right in the middle of your county and started visiting the first-responder agencies, giving them trinkets and calendars and "education" in exchange for calling them instead of the county 911 system, and then when they're called they go L&S to every scene and L&S from every scene to the hospital. And then a year later, another commercial ALS service does the same thing in another part of your county. The original, high-quality county-based service is now struggling and has little choice to compete on the same level as the commercial services. What would the results likely be? A dramatic increase in safety issues, a dramatic overuse in ALS intervention and emergent transport, a dilution of skills among clinicians, and at the end of it all, the whole system would be such a mess ALS would appear so ineffective and unnecessary that people would be questioning whether whether paramedics even bring any benefit at all.

If we could limit HEMS utilization to really sick patients in areas with long ground transport times or entrapment, and staff well-equiped, medium twin helicopters with only really highly trained and experienced (dual) pilots and clinicians, then I think we would spend less overall, safety would improve dramatically, and the clinical benefit to the patients would definitely be there.
 
Remi said:
If you are going to compare apples to apples, then I think you can only compare miles flown (or HEMS transports completed) to miles driven (or ground transports completed) emergently. There's just not a reasonable parallel between the millions of miles of medical facility --> back to the nursing home transports and the rollover with ejection --> trauma center transports. And I think once you do that, you'd probably find that flying is not less safe, and is perhaps even more safe.

Look into the stuff written by Dr. Ira Blumen. He's an EM physician from Chicago who has been involved of lots of detailed analysis of HEMS industry efficacy and safety. Overall he's very critical but he's also fair and his opinions are very fact-based.

The HEMS industry has a lot of room for improvement. I'm highly critical of what goes on in many parts of the industry but I also very firmly believe that a properly designed and utilized HEMS system is a very valuable and appropriate resource in many (certainly not all) areas. There's also the argument that a single HEMS unit can replace numerous ground CCT units over a large geographical area, making a helicopter actually more cost-effective than ground CCT units; that analysis came out of a study done in one the areas I used to fly.

Most of the problems in HEMS, IMO, are either directly or indirectly related to the dramatic overuse that has resulted largely from the proliferation over the past 15 years of "community-based programs". What has happened in HEMS since the mid-90's is like what would happen if a commercial ALS service set up an ambulance base right in the middle of your county and started visiting the first-responder agencies, giving them trinkets and calendars and "education" in exchange for calling them instead of the county 911 system, and then when they're called they go L&S to every scene and L&S from every scene to the hospital. And then a year later, another commercial ALS service does the same thing in another part of your county. The original, high-quality county-based service is now struggling and has little choice to compete on the same level as the commercial services. What would the results likely be? A dramatic increase in safety issues, a dramatic overuse in ALS intervention and emergent transport, a dilution of skills among clinicians, and at the end of it all, the whole system would be such a mess ALS would appear so ineffective and unnecessary that people would be questioning whether whether paramedics even bring any benefit at all.

If we could limit HEMS utilization to really sick patients in areas with long ground transport times or entrapment, and staff well-equiped, medium twin helicopters with only really highly trained and experienced (dual) pilots and clinicians, then I think we would spend less overall, safety would improve dramatically, and the clinical benefit to the patients would definitely be there.
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Isn't there a certain parallel to IFT HEMS flights and IFT GEMS or discharge from hospital? Clearly the patients are typically sicker (or should be!) during HEMS transfers to tertiary care centers, but in all of these cases the patient has been managed to some degree, both the originating and destination locations are known and clearly marked, and likely hazards on both sides have been mitigated as much as possible. What percentage of HEMS missions in the US are scene flights vs. transfers? I imagine there are differences in accident rates between the two. Comparing "transports completed" could be reasonable, but even then you'd have to compare it to "transports attempted."

Believe me, I'm not trying to argue the finer points of costs, use, or efficacy. I believe there is great value in a well managed and efficiently utilized HEMS system, but my thoughts of the day were more focused on accident rates. Adding the risk/benefit analysis component to the debate certainly complicates the argument. I'll look into reading Dr. Blumen's papers.
 
Anjel said:
Ours is 0.3mg 1:1000 IVP in patients "near cardiac arrest". Standing order.
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Sorry that was a 5am typo. 0.3mg 1:10,000
 
MrJones said:
OK - I'm confused. Are there some typos going on around here or are there really systems that use undiluted epi 1:1000 as an IV medication?
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Anjel said:
Sorry that was a 5am typo. 0.3mg 1:10,000
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Is there a difference between a given dose of 1:1,000 and the same dose of 1:10,000?
 
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