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> 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 h

> 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.

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.