4 ms·

“The chairs and equipment are quickly pulled out and rearranged, and a boy -- conscious and without any obvious major injuries -- is strapped to a stretcher acr

“The chairs and equipment are quickly pulled out and rearranged, and a boy -- conscious and without any obvious major injuries -- is strapped to a stretcher across the floor of the helicopter. I wedge myself back behind the pilot's seat and within 25 minutes from when the call came in, we've delivered him to the roof of the John Muir Medical Center in Walnut Creek.” An absolutely outrageous misuse of resources for a patient who did not need air evac. These flights aren’t cheap and the patient and family are billed. This isn’t one of those ignore and it will go away kind of medical bills either - it will be a charge from the city for $10,000+ and will absolutely go to collections. There isn’t a trained air medic on board nor is there appropriate medical equipment to handle a patient who needs emergency life saving care and rapid delivery to a trauma 1 hospital. In other words, a patient who qualifies for emergency air evacuation. Strapping a stable and visibly uninjured patient to a gurney and flying to the hospital isn’t helpful, it’s idiotic. We already have enough bullshit trauma 1 activations. There’s no need for more, much less ones delivered by bored traffic pilots.

mikestew 4y ago
I wasn't arguing that it was a good idea, only that it took place in contrast to OP's claims.
ARandomerDude 4y ago
> But then a call comes in over the radio...med-evac requested... Thankfully, the police officers received a call for help and responded to it. It's not too hard to imagine what would happen if a person had internal trauma and an unskilled observer said "nah, you look fine." We quite literally could have riots over a cop letting a person die like that.
- Pigalowda 4y ago
  That’s not the way triage works. There should be a regular ground based EMT or other trained first responder on the scene to assess the patient and determine if an air evacuation to a level 1 hospital is necessary. If deemed necessary then the judicious use of this expensive resource can be performed. An untrained person unprofessionally assessing a patient in the field and then asking for an air evacuation should not happen. At bare minimum the first responder should be trained in performing a trauma survey and checking vital signs. However, there must be situations in which evacuations such as this example are performed inappropriately. Once an evacuation is requested it’s dutifully performed, inappropriate or not. The example in the article is one such case. A non-medical helicopter without proper equipment for life threatening injuries was used. And as you said, if this person had internal injuries and destabilized during flight - what would they have done? Could they place an IV or do intraosseus access, give a fluid bolus, provide Epinephrine/vasopressors, or protect airway and intubate? Can they perform CPR? This evacuation was purely a ride and not properly staffed or equipped for a patient with life threatening injuries or for a patient at risk of destabilizing. The pilot shouldn’t have taken the patient nor should the air evac been requested.
  - FireBeyond 4y ago
    This definitely sounds like a failure in the system in your area. Here (PNW) any first responder (but not LE) can _request_ airlift. Specifically in my county: > Any field provider may request air transport via [our 911 dispatch]. An ALS (Advanced Life Support/paramedic) upgrade is required. Transport necessity and destination shall be determined by the ALS provider in consultation with the medical control physician on duty. "if this person had internal injuries and destabilized during flight" Well, in that case, bluntly, the choice of transport probably isn't the biggest concern. Secondarily, our protocols also discuss transportation by ground to a lower tier facility that's close to provide some stabilization before air transport to an appropriate facility.
    - Pigalowda 4y ago
      I’m also in PNW and we agree - a trained first responder or EMT can request air medivac. Once approved it sets in motion a system that will deliver the patient (unless the patient refuses in the end). Also destabilization during air medivac is not uncommon, choice of transport does therefore matter. The flight nurse is very capable and able to perform immediate life saving procedures during flight. Medivac flights aren’t just helicopter rides, there’s active treatment going on. And in the case of a patient who is stable but could deteriorate there is the potential for immediate response.
FireBeyond 4y ago
> We already have enough bullshit trauma 1 activations. What is a trauma 1 activation? I get what it's meant to sound like, but that's not a phrase I've heard in 12 years as a paramedic (but that will no doubt vary around the country). In this area it's Code 3 (i.e. critical) Trauma, and has nothing to do with the Trauma designator of the target hospital. As for bullshit activations, in most places, this is done by a tool often signed off by the state under medical direction: https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs//530143.pdf https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs... One of the reasons to do this is to try to remove "emotional" considerations, and stick to objective criteria. Another similar thing is for Airlift pilots, where they are deliberately not given patient information when they are determining whether to fly. They are told pick up point and destination only. This is to avoid, "We really shouldn't have flown, but it was a toddler with significant burns, so we took a chance on it" type situations.

mikestew 4y ago

I wasn't arguing that it was a good idea, only that it took place in contrast to OP's claims.

ARandomerDude 4y ago

> But then a call comes in over the radio...med-evac requested... Thankfully, the police officers received a call for help and responded to it. It's not too hard to imagine what would happen if a person had internal trauma and an unskilled observer said "nah, you look fine." We quite literally could have riots over a cop letting a person die like that.

Pigalowda 4y ago
That’s not the way triage works. There should be a regular ground based EMT or other trained first responder on the scene to assess the patient and determine if an air evacuation to a level 1 hospital is necessary. If deemed necessary then the judicious use of this expensive resource can be performed. An untrained person unprofessionally assessing a patient in the field and then asking for an air evacuation should not happen. At bare minimum the first responder should be trained in performing a trauma survey and checking vital signs. However, there must be situations in which evacuations such as this example are performed inappropriately. Once an evacuation is requested it’s dutifully performed, inappropriate or not. The example in the article is one such case. A non-medical helicopter without proper equipment for life threatening injuries was used. And as you said, if this person had internal injuries and destabilized during flight - what would they have done? Could they place an IV or do intraosseus access, give a fluid bolus, provide Epinephrine/vasopressors, or protect airway and intubate? Can they perform CPR? This evacuation was purely a ride and not properly staffed or equipped for a patient with life threatening injuries or for a patient at risk of destabilizing. The pilot shouldn’t have taken the patient nor should the air evac been requested.
- FireBeyond 4y ago
  This definitely sounds like a failure in the system in your area. Here (PNW) any first responder (but not LE) can _request_ airlift. Specifically in my county: > Any field provider may request air transport via [our 911 dispatch]. An ALS (Advanced Life Support/paramedic) upgrade is required. Transport necessity and destination shall be determined by the ALS provider in consultation with the medical control physician on duty. "if this person had internal injuries and destabilized during flight" Well, in that case, bluntly, the choice of transport probably isn't the biggest concern. Secondarily, our protocols also discuss transportation by ground to a lower tier facility that's close to provide some stabilization before air transport to an appropriate facility.
  - Pigalowda 4y ago
    I’m also in PNW and we agree - a trained first responder or EMT can request air medivac. Once approved it sets in motion a system that will deliver the patient (unless the patient refuses in the end). Also destabilization during air medivac is not uncommon, choice of transport does therefore matter. The flight nurse is very capable and able to perform immediate life saving procedures during flight. Medivac flights aren’t just helicopter rides, there’s active treatment going on. And in the case of a patient who is stable but could deteriorate there is the potential for immediate response.

FireBeyond 4y ago

> We already have enough bullshit trauma 1 activations. What is a trauma 1 activation? I get what it's meant to sound like, but that's not a phrase I've heard in 12 years as a paramedic (but that will no doubt vary around the country). In this area it's Code 3 (i.e. critical) Trauma, and has nothing to do with the Trauma designator of the target hospital. As for bullshit activations, in most places, this is done by a tool often signed off by the state under medical direction: https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs//530143.pdf https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs... One of the reasons to do this is to try to remove "emotional" considerations, and stick to objective criteria. Another similar thing is for Airlift pilots, where they are deliberately not given patient information when they are determining whether to fly. They are told pick up point and destination only. This is to avoid, "We really shouldn't have flown, but it was a toddler with significant burns, so we took a chance on it" type situations.