So another fun debate looming over the EMS Blog-o-sphere is the great flying debate. I have lost count over the last few months of just how many great men and women have died during an Aeromedical Crash...and not the fixed wings either, the helicopters are going down. Many in the blogsphere and on other EMS websites like EMS1.com and JEMS.com all have articles relating to the necessity of flying patients. Questions are raised like, Is flying needed? How much time is really saved? Is it worth the risk? What can they do that we can't?
Oddly enough, my career path is going into being a Flight Medic. I wanted to be a flight medic before it was cool. (Okay, it's always been cool, but go with me on this one.) I have always respected them to the highest, and not because of their awesome flight suits, but because of what they did. They go in to major accident scenes and rescue those who can't be helped due to the lack of adequately trained ground personell.
Or so I thought...
When I did my flight time that was required by Paramedic Program, I got to see up close and personal just what they did. I never flew once, the weather was horrible on each day that I went. I chatted with many flight medics, nurses, and even pilots. I asked the same question, Is Flight Medicine really that important? Do you need to come out on EVERY car accident scene that has a bent in door, or car fluids leaking, or for every patient that is more than twenty minutes from a "specialty resource center?" Is it worth risking your life every day?
The answers I got were amazing. From the expected, "Everyone working with me is awesome and we can fly through anything 'cause our pilots are awesome." to the unexpected, "I like going on scene runs, but constantly going out on calls that Basics could handle, just because they are more than twenty minutes from (insert trauma center here) gets a little on the crazy side."
I had to agree with them. I know I don't have any good scientific facts like RogueMedic or as witty as Ambulance Driver, buthere are my direct obsversations.
I came from a county where, we had at least a Level 2 Trauma Center within 20 minutes of anywhere. As much crap as I gave the outlying hospitals, I had to give them their credit when it was due for stabilizing truly bad accidents when no one could get them into the city for the Trauma Centers. On the other side of things, in XYZ county where I came from, we had 4, not one or two, but FOUR Level One Trauma Centers within 10 miles of each other and on any side of the county, were no more than twenty minutes from one of these centers.
I have personally witnessed the rampant abuse of Aeromedical. We had a bad traffic problem, and we'd notice the use of helicopters would go up during rush hour traffic and when there was a sporting event in town. Even though there were thirty different ways to get to each center, because the main (and shortest by mere seconds) route was full, the bird would go up.
What most people don't realize is, the ETA for the helicopter is just flight time. They don't include the 10-20 minutes for everyone to wake up, answer the call to nature, check the radar to make sure there isn't going to be a severe weather event where you are headed. Then you have to do the pre-flight check, get the blades turning fast enough, then get to the scene.
So, if there is an ETA of twenty minutes, the true ETA can be almost fourty minutes for the bird to even get to you. Then you have the transfer of care, the changing over of equipment, changing from one stretcher to another, then the patient is loaded into the helicopter and they take off. We're talking about almost an hour of someone sitting with their thumbs up their asses waiting for the almighty helicopter to land and whisk their patient away.
I am not calling for the immediate halt of flight services. There are many places that need helicopters to come in. I live in a place now that they fly ANY critical patient where the trauma center is. Now, it's a ninety minute, if not longer depending on traffic drive in, so I can understand, but where is the fun in that? Most of the people I work with have not handled a severe trauma patient. There are always helicopters near by, so the patient has barely been taken from the wreck before they are loaded into a helicopter.
I believe that a change needs to come though, but it has to come from everwhere. We have to stop teaching EMT's and Medics how to manipulate Medical Command Doctors into allowing the bird to come in. We need to start teaching that, it's okay that your patient has a Femur fracture...that's why the Hare Traction Splint was invented. Slap that puppy on and head for the nearest hospital if they are that bad, or to your local trauma center.
Doctors at the outlying hospitals need to pull up their big boy/girl panties and actually do what they were trained to do: play doctor. No more telling ambulance crews that you don't take "That kind" of patient. No more freaking out when someone comes to you with more than a scraped knee. No more screaming at ambulance crews for not taking them to a "better hospital", and no meeting them in the ambulance bay when they come in with a patient who is trying to die (and doing a helluva job at it) and telling them that you're going to pull their numbers if they don't take their critically ill patient somewhere else (true story).
We as EMT's and Medics need to start taking pride in our work. We wonder why they take things away from us like Intubation and agressive Trauma Protocols. They do that because a majority of us act like we can't do it! On the outside, those medics (outside of extremely rural areas, or places that have drive times of two hours or more), who call for birds constantly name key phrases such as, Extended transport time/distance to specialty resource center. Possible Airway Compromise that cannot be handled in the field. Or my favorite one, The patient has an Altered Mental Status that may continue to decline and make ground transport risky.
We all know that most of these medics just don't want to deal with it. They have something to do right after they get off of work, and the ground transport will cause them to miss their event, so they call a bird. Too Tired after running all night? Call a bird. Don't want to deal with a drunken, crazy patient that you can't sedate and tube because of protocol? Call a bird! We bitch, moan, and complain when we are dragged out in poor weather, citing that, because we're in an ambulance, we may wreck and get injured or killed. What about those who are up in the air thousands of feet? They don't have that 50/50 chance, or even a 40/60 chance. Their chances of dying if that hunk of metal and fiberglass decides to fall from the sky is over 70%! We have seatbelts and airbags...they don't.
Across the board, we need to change. We have to stop calling the birds in for "questionable" situations. If you have to think whether calling the bird in or not is a good idea, then you can probably drive the patient to the closest hospital and let them treat/stabilize, or drive them to the trauma center yourself. Other than giving blood products and doing RSI, we can do the same thing they do! Nothing they do is going to make a world of difference (except for blood) in our patients.
Medics! Start taking pride in your work. If we spend our time flying every patient, it dumbs us down, making us look as if we can't handle ANYTHING, location issues aside.
Before I close this out, I just want to say that, I love my Flight Medics and Flight Nurses. I have had the pleasure of being able to work with them going through Medic Class, and even outside of medic class in other areas. For locations that need them, they are a Godsend, and I pray that they go up in the air safely and come back down just as safe. At the same time, I am very proud to say I've not broken my Flight Cherry. I love my Trauma Patients too much to let someone else take them in.
Not saying that I won't use them here, especially since drive times to a Trauma Center are horrific, but I believe I'll be very limited in my use of them. I believe (read: hope and pray) that the local hospital can stabilize Trauma's, STEMI's and CVA's (Heart Attacks and Strokes for those who aren't used to the nomenclature). If not, then I guess I'll be flying more people than I'm used to.
In my next post, I'll give you a call I had when I worked in the Land of Many Specialty Resource Centers, tell you how it played out, and my other thoughts on if Air Transport Services are being used and abused like a two dollar whore on half off night.
Until then, Have fun and Be safe, My friends!
~M. Trommashere~
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