Re: Combining of Existing ground w/new flight program

["Andrew Berry" <Aberry@nets.org.au>]

This may not answer your question but the following may show how we manage the 'relationship' between different components of the critical transport process.

Our program is based around a certain specialty - it is in fact paediatrics as your example. We are a clinical service for neonatal, infants and older children plus teletriage quite a lot of perinatal (obstetric) calls. 

Our relationship with aircraft is similar to that we have with ground vehicles - viz. that they are carriers. They provide a small amount of real estate in which we can establish a mobile critical care presence. Some crudely describe them as simply being 'the taxi' for the critical care team.

The critical care transport process is 'run' around a clinical discussion between a minimum of three parties - the referring clinician(s), their preferred receiving clinician(s) and our service providing a communication gateway between them. At a very basic level we are a 'switchboard' which intelligently connects the referrer with a doctor at the appropriate level of seniority required. The level of seniority is determined by the principle that the referrer should have access to a more senior or experienced doctor with whom to discuss the case. This is akin to the transport principle of always going 'up' in level of care, not 'down' as the result of using a transport platform.

Our service provides a consultant ('attending') level clinician to 'chair' that process. He is located on the end of a phone somewhere. At present some of our rostered consultants are not even in Sydney where our teams are based. One is in the UK - he does the night calls in his 'daytime'. It really doesn't matter.

I think we have had a chronic problem in air medical transport of seeing the vehicle as the centrepiece. How many newcasts describe the patient as being saved by the helicopter? I have never seen a helicopter make a diagnosis, intubate a child or counsel distraught parents. Worse still, sometimes a helicopter is sent unnecessarily at high cost, when the very basis of dispatching it is later questioned in clinical review. In our country we have had helicopters (and other vehicles too) crash with loss of life; on missions which were never clinical justified. I suspect that may be true elsewhere too.

Therefore my view is that vehicles and clinicians live in separate but closely linked 'domains'. A single transport service may not be the best outcome for you if it combines or inter-twines these.

Happy and safe co-habitation!

Dr Andrew Berry ABerry@nets.org.au
State Director
NSW Emergency Transport Service 
www.nets.org.au

Hotline    1300 36 2500   +615 0055 NETS
Office      05 005 24453   +615 005 CHILD
Facsimile 05 008 24453   +615 008 CHILD
Direct      05 005 23779   +615 005 BERRY

>>> maarmstr@hsc.vcu.edu 8/11/2001 2:25:07 >>>
    I would like some input from other transport programs with  ground
and flight teams that existed in a certain specialty (ie
pediatrics)prior to having the aviation component added that was under
another department. Did all your teams eventually combine to become one
transport service? If so what was the timeline and how did it happen? If
not why?

Our hospital a ground pediatric program in existance for ~10yrs, a
neonatal ground team for~ 20yrs, and now a brand new mostly adult
medical/trauma helicopter.All are run under different departments, we do
not have one transport service governing all.
You may email me directly if you wish......lmulas@hsc.vcu.edu 
Thanks


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