----- Original Message -----
Sent: Tuesday, October 01, 2002 4:21
PM
Subject: Re: Helicopter
risk/benefit
Wesley,
The patient or family doesn't decide what vehicle is used for the
transport. If the MD said by air, and the patient said by ground, would your
former program send an aircraft? You wouldn't know what the
family/patient said. Second, the patient is not yours until sometime
after you arrive at the transferring facility. Any decision about
patient care up to that point has been made or approved by the referring
physician. So the decision to fly has already been made, or else you
wouldn't be there. So when did the patient/family get involved?
Before you arrived at that facility. The MD had to make a decision about
the patients needs, had to confer with another facility (MD) to accept the
patient, and then decide how the patient should be transported. Did this
include a consultation with the family or patient about treatment options, and
the potential risks associated with flight, it should have. Would a
consultation like that meet those needs? Again, a decision was made to
fly and your program got the call requesting they transport the patient.
If the patient transfer sheet doesn't meet your programs needs, to include the
risks associated with flying then your program should talk to that hospital
about changing their form. That would be much better than the following.
Your former program receives a call from a hospital asking if you could
transport a patient by air. You get dispatched to that hospital, go to
the bedside, and then discuss the safety issues of going by air with the
patient/family. Afterwards, the family or patient tells you they don't
want to fly. Do you pack up your equipment and fly home? This
would be a time consuming and cost prohibited procedure, and find it highly
unlikely that any program operates this way. Not that patients don't
occasionally refuse to fly, they do.
The decision to go by air vs ground has to be made by the transferring
facility. The referring MD knows the status of the patient and what
treatment they need. They have the responsibility to inform the
patient/family of those treatment plans and the risks associated with
them. To include, the need to be flown to X hospital for a procedure
they can't do. The patients injuries and possible time constraints on
receiving the appropriate treatment are what should dictate the form of
transportation. The person with that responsibility is the MD at the
referring facility.
If the referring MD says my patient needs to be flown, and your program
arrives at the bedside and decides to discuss the safety issues of flying and
scares the patient into not flying, what potential liablility issues have you
assumed?
Reference preflight safety briefings- Any passenger (non-patient) receives
a safety briefing. Patients don't take actions during an
accident/emergency. The medical crew is totally responsible for the
patient when loaded in the aircraft.
Bob Carnevale
Wesley Copeland wrote:
First of all, it is not the transferring facilities
decision as to how a
person is transported. They can make a
recommendation that the patient go
by air but it is the patient or the
guardian who has the ultimate decision
and they do have a right to
refuse air transport based on safety if they see
fit. As health
care providers we all have the responsibility to inform our
patients of
the pro's and possible cons of any and all procedures to include
transport. Do you follow FAA regulations and provide your patients
with a
preflight safety briefing? By explaining to them the
actions to take in an
accident/emergency aren't you also telling them
that an accident/emergency
may occur? At the flight service I was
with, it was our policy to explain
the risk of transport. While
doctors do write "accident" on the transfer
form under the "risk"
section I have never seen a doctor actually explain
this to anyone.
Wesley Copeland, FP-C
