Re: Ground Vs. Air

[lanelson1@juno.com]

I would like to address this, as I lived in the Navajo Nation... 

Eric writes: 
> > The fact that your ambulance service has had a bit of bad luck 
> with loose animals on the roadway does not justify a helicopter 
> transport for every patient that needs to go to a tertiary facility. 

Paul Writes:
> But, Eric, you don't understand.  These are not just "loose animals 
> on the roadway" - they are genuine Arizona-bred Ambulance Eating
Horses.  
> I've encountered them and they are fairly frightening.  They look much 
> less intimidating from 500 ft AGL than they do eye-to-eye through the 
> windshield of your Type II van.

Larry's Comments:
When I was at Chinle (Just down the road from "K-town"), One of the
"Arizona-bred Ambulance Eating Horses" that Paul alludes to tried to take
out a Seneca and it came out a draw...both lost... but no humans were
permanently hurt in the production of this picture.

The area is open range, and we are talking about 1/5th the land mass of
Arizona! There are more goats and sheep than in Great Britain (before
Foot and Mouth). Horses, cattle, goats, sheep, dogs, and just about
everything that shipped aboard the arc that is hardy enough to tolerate
the Arizona high desert wander the roads.
 
> In fairness, there are a number of other challenges beyond driver
> competence/horse avoidance.  If the patient requires a level of care 
> beyond that of the ambulance crew (a common scenario in rural areas),
the 
> rural facility ends up committing a staff nurse to the transport.  For
a 
> transport to a hospital 75 miles away, the round trip represents half a
shift 
> of coverage.  

Larry's Comment - 

There is NO tertiary care NEAR the Navajo Nation!

In the winter, it is not unusual for the average speed to be 10-15 mph,
otherwise you might wind up at the bottom of a 200 foot drop. The fall
isn't so bad, it's all the bouncing, flipping, screaming, and that sudden
stop.  

Up to a year and a half ago, there was NO CAT scan in the Nation.
Anything of any severity was given emergency surgery (if a surgery was
available) and transported, or sent out directly without surgery. All
neuro of any severity gets sent. 

 >  I could name some very large flight programs that at some point in
their history have > subsidized their emergency traffic by doing
transports on some other basis than 
> strict medical necessity.

Everything, if the standard of care is to be equal, requires transport
for medical necessity. Don't get me wrong. The nurses, doctors, EMTs, and
other health care workers on the Navajo Nation are among the most
clinically competent, empathic, and ingenious people I have ever had the
priviledge to work with in 25 years of EMS and Nursing. The lack of funds
to provide improved health care is their greatest problem, not caring.
Apache County (strangely enough, the county where most of the Navajo
Nation resides in) is among the most impoverished in the U.S. 

"Leadership is action, not position"
Larry Nelson RN CFRN NREMT-P
EMS instructor - Houston TX
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