Allen,
As I drafted my inital response below to the high risk OB transfer /specialty team issue I knew that sooner or later the the old arguement of response time would be brought up. While response time in scene/trauma scererios is important component in a patienet's definitive treatment, does an extra five to ten minutes in response time waiting for a specialized team in non trauma scereios mean a poor outcome for the patient? Response time is imporant especialy to small referral hopitals who are treating a sick child. It seems somedays you can not get there fast enough for them , a scerierio I see all the time. I had thought by now that Pauul Wright would chime in but as I stated in my responze below sometimes comments beg for a response.You brought up some interesting issues but allow me to address/reply/question some of these issues.
1. " While these teams (ped RN/RT or ped RN/MD) certainly bring a higher level of
>skill and experience than our normal RN/EMT-P crews can provide, I seriously
>think that the significantly extended response times (it routinely takes them
>45-60 minutes to be ready to be picked up after we receive a request for a
>ped trauma transfer) and "at location" times (again, anywhere from 45-120
>minutes at the referring facility; vs the average 20-45 min for our normal
>crews) offset any benefit provided by the higher level of care, ESPECIALLY
>when you consider that I have NEVER seen the pediatric team perform any
>interventions that were beyond the scope of a well trained RN/EMT-P crew.
My first thought is just where in the chain of dispatch does the specialty crew fall ? Do they contact you and then still take that long? In a perfect world programs could afford to have all teams sit around and wait for a call but as we all know it is not a perfect system/world.
We had similar discrepancies in alert/dispatch times but found as the pagers were tagged for a flight, the aircraft crew was one of the first alerted. The specialty team sometimes had an 8-10 minutes delay in receiving the dispatch page. Just by where the teams pagers were placed in the calling list can make a huge difference. We have a fifteen minute response for peds flight and 30 for neonate as the teams are unit based. Once we were on the same alert/start time the apparrent "delays" dropped. Since you have" NEVER" seen special/higher level intervention done by the specialty team, is that because of the fact they properly stabilized the patient prior to departure? In regards to downtime at a referral facility as a probelm could you not drop them off and return when they are ready, therfore not miss a trauma call?
2. In the issue of aircraft safety, any crew resource management program will tell you that safety of all crew and operation of the aircraft falls to the PIC (pilot in charge). Issues of unsafe conduct need to be addressed and corrected by them. They have the authority to intervene is such instances. Almost all who do air med transport realize the risks to this mode of transport as all team members need to communicate and work together. It is not a peds flight verse a regular flight, as it is a patient's flight and they deserve a team who works together.
3. The loss of referrals to the one hospital may be due to physician affiliations? I am sure once the hospital realizes the loss of transfers, they would address and correct issues. Just good bussiness sense.
4. "For what it's worth, our normal flight crews do alot of on-scenes with peds
>(scene calls make up about 60-65% of our total call volume); I don't know if
>this makes us more comfortable with kids or not, but everyone I work with is
>very confident with their pediatric assessment and treatment skills. "
Since 60 to 65% of your calls are scene flights, I assume you percentage of peds/ neo nontrauma flights are a small part of the yearly flight percentage. I have the utmost respect to those who do scene flights. It is a specialzed service done by those who are trained and have the daily exposure to such life threatening occurrences . Their expertise can make a bad situation result in a favorable outcome. Anyone who works peds regularly realizes the myriad of illnesses that befall them and subtle changes may be you only clue a problem exists. Having worked in a couple of major referral facilties, I have seen instances of nonspecialty crews trying to maintain oxygen saturations in the 90's when the child has cardiac defect and is normally in the 70's or not recognize subtle seizures .
I could go on but as I stated earlier, my original post was to respond to the derogatory comments made about specialty teams. It is the patient's best interest we most all work together for, not take pot shots at other medical professionals. Every profession has it's specialty and I guess that is why general practitioners do not do brain surgery. A complex issue that always seems to stir up turf wars......lets do what is best for the patient and leave politics and egos on the helipad.
Regards
Steve Sittig.
>From: Wildmedic75@cs.com
>Reply-To: flightmed@flightweb.com
>To: flightmed@flightweb.com
>Subject: Re: High risk OB transports
>Date: Tue, 24 Jul 2001 09:06:25 EDT
>
>Steve:
>
>I wholeheartedly agree that "Daily experience in any given area lends to
>improved clinical skills and patient care". However, unfortunate as it may
>be, the level of care is not the only factor at play when looking at the
>issue of "specialty teams vs. the regular flight crew".
>
>The program I work for does not use a specialty team for OB calls, but we do
>for neonatal and pediatric transfers (which make up a significant percentage
>our our total responses).
>
>While these teams (ped RN/RT or ped RN/MD) certainly bring a higher level of
>skill and experience than our normal RN/EMT-P crews can provide, I seriously
>think that the significantly extended response times (it routinely takes them
>45-60 minutes to be ready to be picked up after we receive a request for a
>ped trauma transfer) and "at location" times (again, anywhere from 45-120
>minutes at the referring facility; vs the average 20-45 min for our normal
>crews) offset any benefit provided by the higher level of care, ESPECIALLY
>when you consider that I have NEVER seen the pediatric team perform any
>interventions that were beyond the scope of a well trained RN/EMT-P crew.
>Consider, also, the number of potential on-scene calls that we are not
>available for during a 3-hour pediatric transfer.
>
>Aircraft safety is another issue. We send the flight medic along on these
>calls as a safety officer/crew chief, but there is little the medic can do
>when dealing with team members who seem hell bent on doing things their own
>way. The specialty teams are required to attend annual aircraft safety /
>operations / flight phys training, but many of them don't fly often, and for
>the most part, they just don't seem to have enough respect for the airmedical
>environment.
>
>These teams are not employed by the flight service; they come from the closer
>of the two pediatric trauma centers in our region. A trend that we have
>recently noticed is that many of the small, outlying hospitals in our service
>area who used to send most of their ped traumas to this hospital are now
>sending them (almost exclusively, in some cases) to the other ped trauma
>center, which in most cases is a little further away, but does not require
>the transferring hospital to wait for their specialty team to arrive before
>the patient is transported there. Most of the transferring (and receiving)
>physicians are very happy with the level and quality of care that our normal
>crews provide, and they don't want to deal with the added 60-120 minutes that
>it takes to get the kids out of their ER and on their way to definitive care.
>
>
>I have the utmost respect for the knowledge and experience that "specialty
>teams" can bring to critical patients, and I harbor no illusions that being
>PALS or NRP trained makes me as qualified as a ped RN or MD, but again, there
>are other important factors (speed and safety) that need to be addressed. I
>know that the literature in general supports the use of specialty teams, but
>I imagine that most of these studies were looking at either relatively stable
>(non-trauma or non-time sensitive) transports, and the specialty teams
>studied must have had much lower response times than ours do.
>
>For what it's worth, our normal flight crews do alot of on-scenes with peds
>(scene calls make up about 60-65% of our total call volume); I don't know if
>this makes us more comfortable with kids or not, but everyone I work with is
>very confident with their pediatric assessment and treatment skills.
>
>
>Just my lowly little flight paramedic opinion.......any comments?
>
>
>Allan
>Flight Paramedic
>
>
> > << I enjoy the posts here on this listserve and find them very informative
> > but from time to time some statements are made that beg response. The
> > comments below regarding "specialty teams" not know their aircraft etc is
> > was what got my attention. All the issues mentioned, it comes down to
> > training provided by the transport service. At the program I am currently
> > working at, all "team " members are given annual safety trainning and are
> > familiarized with aircraft operations. We also take a regular flight
> > nurse with us on the helicopter as a resource.
> > The literature supports specialty teams in pediatrics and neonatal verse
> > one team fits all. No one can know everything and as it was stated it is
> > the best interest of the patient that we must strive to meet . Following
> > properly set guidelines for high risk maternal transports reduces the risk
> > to the child , mother and potential litigation issues. Your course sounds
> > very interesting and beneficial but some consider that just taking a course
> > then makes them experts and there lies the trouble. Daily experience in
> > any given area lends to improved clinical skills and patient care . So
> > there is my two cents worth. >>
> >
>
>
