Flightmed archive for January-2002
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Flightmed archive for January-2002

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RE: Pt. Scenario

As an emergency physician who has practiced at trauma centers, been
medical director of ground and air EMS services, and currently am chief
at a mid-sized community ED, I have a perspective on this matter.

I agree that egos can play a large role. However, lack of education and
understanding of the various hospitals' capabilities on the part of EMS
can have a major impact, as well. Quite often, people from the trauma
center, or a flight crew, or even local EMS, don't really know what any
given local ED or hospital can handle. When those capabilities change,
these changes (for better or worse) are not always taken into account,

For example, five years ago my current hospital had no trained emergency
physicians, no vascular surgeons, one cardiologist, and poor coverage by
ortho and other specialties. Now, we can handle virtually anything short
of open heart surgery and neurosurgery. If the reputation of five years
ago is still in people's heads, they could make a decision that is not
appropriate for today. If one of the doctors directs EMS to do something
that conflicts with the old reputation (but is appropriate for today),
that doctor could be accused of doing something for ego or money, when
that is not true.

John L. Meade, MD, FACEP
Chief Executive Officer
Emerald Healthcare Group, P.A.
Doctor's Resource Group, Inc.
"The real problem is not whether machines think, but whether men do."
-B.F. Skinner, behavioral psychologist

-----Original Message-----
From: flightmed-admin@flightweb.com
[mailto:flightmed-admin@flightweb.com] On Behalf Of Robert Cole
Sent: Wednesday, January 02, 2002 16:13
To: 'flightmed@flightweb.com'
Subject: RE: Pt. Scenario

good discussion all, I would mention one thing in regards to "cost" to
the small hospitals .  Trauma is by far one of the most money losing
patient populations when compared to other agencies.  When you look at
the resources required for a trauma patient, the cost of personnel, OT,
time away from other patients, etc...now look at the typical trauma
patient is the uninsured and a major health care expense will cause them
to declare bankruptcy...is make the expenses near unrecoverable.  I
would think that if cost were the issue, small hospitals would love to
send them on.  The reality (IMHO) is that Ego's play a far larger role.
What doc (or other health care
professional) likes to admit they are over their head? I know that as a
medic I have trouble admitting it.  It goes contrary to what I am.  Docs
are no different, often worse.  Its been that way since the early days
of shock trauma.

Robert S. "Steve" Cole
Paramedic, CCEMTP
Education Department
Ada County Paramedics 

"...A mind stretched with new ideas never regains its former shape"

-----Original Message-----
From: James.J.Misuraca@Hitchcock.ORG
Sent: Wednesday, January 02, 2002 12:00 PM
To: flightmed@flightweb.com
Subject: RE: Pt. Scenario

OK lets take this one out of the realm of the flight crew. Lets pretend
we are Dr.Joe Elemdee at the Center Barnboard Health Center. The local
ambulance has had several of these calls this year. To his estimation,
none of them have been as severe as they sound when they are dispatched
or when they patch in with scene info. 
"Do I take a chance and bring them here first or do I send them 30 miles
away to Trauma Center without ever seeing them?" As one responent
recalled her observation of the Kansas region we struggle with these
issues in the Vermont/ New Hampshire region. Politics, goverment,
weather, etc.... have conspired to limit our scene response and cause us
to struggle with this senario on nearly a daily basis. How can we make
this sort of descion making less painful/ costly for the small
providers? At what level of education or goverment protocol do we draw
the line on excessive evaluation by centers that are not equiped to
provide care? How do we do this and appear to be the "adjuncts to
improved patient care" that we know we are versus "the money hungry
trauma scavangers in thier expensive toy" Excuse me, devils advocate

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