RE: transport time (school assignment)

["Pufahl, Jo" <JPufahl@smdc.org>]

I have been following this thread closely.  We have been in service since
1989 and still have one or two pockets of "time controversy" that still
exist.  One rural hospital is 80 miles from our Level II trauma center.  The
road is a two lane, heavily used (lots of semi truck), runs through several
low cedar swamp type terrain, lots of curves, hills, deer, bear, moose,
snowmobiles, train tracks, etc.  This particular ambulance service believes
that they can get their patient from their facility to ours faster than we
can get to them, get the patient, and return to the trauma center.  (Be
advised we are not allowed to land at the hospital, but must go to the
airport and be transported in to the hospital to retrieve the patient, then
return to the airport for transport.)  This ambulance service routinely
drive 75 - 90 miles/hour on this highway and are proud of their speeds.
Under the above circumstances, they can get their patient to our facility a
hair faster than we can by RW.  

However - This 80 miles of transport is in what can be considered to be the
unstable environment, subject to multiple external forces they have
absolutely no control over.  The 75 miles of flight distance is in a
straight line, no deer, moose, bear, trains, trucks, snowmobiles to fight
with.  Red lights and sirens do not guarantee that they will be given the
right of way.  (I've not seen a deer pay much attention to the red lights
yet.)  The only external issue during flight is the occasional bird or
plane.  We are given priority through the air space as LifeGuard status and
planes give us the right of way.  In the normal scope of operation, the
helicopter normally flies at 120 - 160 mph in a straight line with few
distractions in a relatively smooth pattern.  In the normal scope of
operations, road vehicles (including ambulances) should be obeying the
posted speed limits (not traveling 80 - 90 mph). Personally, as suggested
earlier, I would not want to be in a ground unit at 90 mph over rough roads
(frost heaves are great right now) with the potential for rapid stops,
turns, accelerations, etc if I am seriously injured or ill.

As to the time frame, I have yet to see an ambulance "beat" the RW from the
same given starting point to the same given finish point.  A great advantage
in pre-hospital care/transport is the simultaneous or at least
standby/launch status that can be awarded to the RW as well as the local
ground services.  Then, if rapid transport with high level of technical
support is needed, it is right there at hand and the patient can only
benefit.  If the patient is assessed and doesn't need the high level of
skill or the rapid transport, the RW can be cancelled, the patient  can be
transported by ground at a leisurely and comfortable pace for all concerned.
We have an excellent system for simultaneous dispatch in place in our region
- however, I think it is frequently under-utilized in many cases.  I am sure
this is common throughout the country.

I am very interested in what others have to say and am very interested in
your finished paper.
Jo Pufahl, RN, EMT, CFRN, CEN
SMDC LifeFlight, Duluth, MN

-----Original Message-----
From: JRLunde@aol.com [mailto:JRLunde@aol.com]
Sent: Wednesday, March 27, 2002 9:28 AM
To: flightmed@flightweb.com
Subject: Re: transport time (school assignment)


I appreciate your comments. I can only speak for what level of care the 
ground crews can provide in my state. The fact still remains that an 
RN/Paramedic team are a higher level of care than a Paramedic/Paramedic or 
Paramedic/EMT configuration. I do not know of many states that allow for 
pericardial taps by ground EMS units and the use of RSI protocols.

Thanks

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