RE: Helicopter risk/benefit

["Tom Waters" <tom@tomwaters.net>]

Title: Message

Dr. Thomson-

 

Thanks for your comments.  We had several issues:

A} Our actual medical director is off hunting.  Hunting takes precedence over EVERYTHING in Wyoming, and I would certainly have been chastised for going over another ER doc's order.

B} In our system, RN's are responsible for inter-facilitiy txpts, no matter what.  There is nothing on the books EMS or RN side, it's just how it is mandated.  A paramedic cannot possibly understand or handle an interfacility call is the mentality of this place.

(this call did go well dispite the issues, b/c the particular RN and I work well toghether, don't tell anyone, but as a
"team" )

C} The referring doc did not have the ability to do the intubation (and could not manage the dysrhythmia either)

D} Our trauma director called me yesterday to follow up, it is just now trickling out that this call happened.

E} It was the RN who "asked for permission" from the receiving doc. If it were me, I would have asked for forgiveness at the other end.  To her defence, I don't think she anticipated being told no, and I would not have expected it either.  The doc is normally not that wsy.

F} Our medical director will see it, but he won't take any action.  He is dictated to by the Program Director, an RN.  He does not have any stroke with issues when they arise.  Case in point, a pt needing intubation on another call, the medic (me and 1 trainee) "begged" for 2 hours that it needed doing, the RN refused, The pt was intubated upon arrival at the receiving facility by a resus team.  A debrief was done, new policies were invented, but when it came time to implement them, the Program Director changed her mind, in lieu of the RN's and of course, the Med Dir is off hunting so could not comment to the collective (strategic timing of the meeting)

 

Yep, there are some underlying serious issues here. 

I almost replied privately, but others who have issues such as these who may have found solutions might just be able to offer them for the good of our poor patients.

 

Thanks Again for raising these to the light.

 

Tom Waters

NREMTP / CCEMTP / Flight Paramedic

Wyoming Medical Center / Life Flight

Casper, WY 1-800-442-2222

-----Original Message-----
From: flightmed-admin@flightweb.com [mailto:flightmed-admin@flightweb.com] On Behalf Of Helodoc@aol.com
Sent: Wednesday, October 02, 2002 9:27
To: flightmed@flightweb.com
Subject: Re: Helicopter risk/benefit

In a message dated 01-Oct-02 18:06:17 Eastern Daylight Time, tom@tomwaters.net writes:

But... Our receiving ER doc would not let us do it, and said put the pt in their ambulance then and send him by ground.

Was this physician your medical director?  If not, I think this would have been the time to get the medical director involved.  It is pretty clear to me that this physician probably did not have a good handle on the system issues involved.  Money being a secondary (but important) issue, the ground transport took two systems (yours and the ground ambulance's) to a lower level or completely out of service for two hours.  That is a significant disservice to the region.  There may also have been issues about whether the RN had any legal standing as a healthcare provider in a ground ambulance. (Depends on your state EMS and Nursing laws) The referring physician and hospital also had an expectation which was not fulfilled.  This may color future interactions unless you provide a significant amount of education to explain the decision making process (my doc said "no" is just not good enough).  Finally, did you consider asking the referring physician to intubate the patient?  Then it would have been a fait accompli and you could have kept the patient sedated and flown back.

Be sure this trip is reviewed by the medical direction and the management so that the craziness can be averted in the future.

Dave Thomson
David P. Thomson, MS, MD, FACEP
Associate Professor
Director, Transport Medicine
Medical Director, Telemedicine
Department of Emergency Medicine
Upstate Medical University
Syracuse, NY 13210
315.464.6219 (voice)
315.464.6220 (fax)