Scenario:
08:00: An ambulance and fire engine are dispatched to a rural community for a possible cardiac arrest. Both resources have an ETA of 25 minutes to the scene.
08:05: The ambulance crew asks for an air ambulance to be placed on standby.
08:07: The fire company follows the lead of the ambulance and asks for a second engine from a nearby rural community to respond and setup a landing zone nearby.
08:27: The fire engine arrives on scene first to find an elderly male in cardiac arrest. He has been without CPR for at least 28 minutes that they know of.
08:28: The fire crew launches the helicopter.
08:30: The ambulance arrives on scene and transports the patient to the landing zone.
08:45: The crew arrives at the landing zone and hands off patient care the helicopter crew. The helicopter crew terminates efforts and leaves the patient on scene for the coroner to pickup.
A number of things went wrong here. I understand putting an air ambulance on standby, but for a cardiac arrest? Not so much. Let’s remember that not only is the pre-hospital survival rate of cardiac arrests extremely low, but throwing a 25 minute ETA with no CPR pretty much seals that deal. Before anyone got on scene and actually assessed the patient, a second engine was dispatched leaving their response area unmanned. The helicopter got on scene and did what the ambulance should have done before leaving the house. There just isn’t any sense in transporting, let alone flying a cardiac arrest patient that has been down for that long. Hell, there isn’t a lot of sense in transporting cardiac arrest patients without ROSC period, but that’s another complaint for another post.
I could probably transition from my last post on intubation directly into this one as I pretty much feel the same way about HEMS as I do pre-hospital intubation. Both tools are extremely critical, extremely useful and extremely abused. Just like intubation, air ambulances are great when used appropriately and dangerous when abused. And just like intubation, if we keep over-using helicopters for stupid reasons, we will eventually lose them.
It almost seems like we look for reasons to use the helicopter, rather than actually doing what’s right for our patients. And when I say “doing what’s right”, I mean medically, and yes, financially. When you fly someone out for a hurt knee and they are discharged before the helicopter makes it back to quarters, then your patient will have a very negative outlook on their experience. Their insurance isn’t going to pay $14,000 for something that could have gone by a BLS ambulance. I hate to put a price on injuries, but sometimes you have to think that way. Sometimes you just have to step back and say “would I want to pay $14,000 for this ride?”. Sorry but this stuff isn’t free, and a helicopter bill could absolutely devastate someone.
Now before anyone says that I’m putting money before patient care, let me assure you I’m not. If I had a skull fracture and a GCS of 6, then I would want that ride without a doubt. There is no price I wouldn’t pay for a chance at survival. However, you would be hard-pressed to convince me that you made the right choice 4 years from now when I’m still paying on my bill for being flown out with an arm fracture.
On the operational side of things, using a helicopter without good reason is also harmful. Most areas are only served by 1 helicopter and using it for a non-emergent reason means that the truly ill or injured person that needs it 30 minutes from now isn’t going to have it available. It’s all about using resources wisely. I like to think of it like a budget, or even better, a backup gun.
Every time I hear someone argue that we “don’t have x-ray vision”, or “don’t know what’s going on under the skin”, I inform them that they would do great in a hospital setting. As EMS professionals we are trained to identify life threatening injuries and illness. Stop looking for something that isn’t there. It doesn’t matter how bad the car looks, if your patient is stable, then your patient is stable. Do your job and transport the patient.
Helicopters are a vital resource, and I want to see them continue to have a role in the pre-hospital setting. But unfortunately with all the air-ambulance crashes, poor reimbursement on non-urgent calls and general abuse of the system, it’s just a matter of time before legislation crippling our ability utilize the resource starts to emerge. We need to start focusing on assessing the patients, and just doing what we are trained to do.
I recently started using Google Maps to assist in training new paramedics that come to work at my place of employment. Several of these people come from different cities, and in some cases different states. Either way, learning a large metropolitan area in a matter of weeks can be a challenge.
I would like to share with you all a trick that I learned a little while back for dealing with patient’s that are hyperventilating. I’m sure you have all had that patient who is breathing 28 times a minute after their boyfriend dumped them or had some type of stressful event. This usually leads to Carpopedal Spasms which often leads to even more anxiety. Getting your patient to slow down and regulate their breathing pattern can be very difficult. The technique that I am going to explain has proven to be helpful to me, but it isn’t perfect as it requires your patient’s participation.
So there I was, sitting in the back of the ambulance cleaning up after running a combative patient that was under the influence of meth-amphetamines. My partner and I were wading through the wreckage that this outstanding citizen caused. Kind of like people do when their homes get demolished by tornadoes. I looked at my partner – who happens to be brand new – and told him that he did a good job on the call. He looked up at me with a confused stare and replied, “are you being scarcastic?” I explained to him that he stayed calm and did a great job with getting the restraints placed on the patient in a timely manner. ”Um….thanks, nobody ever gives me feedback so I don’t really know if I’m doing a good job or not”, he replied.
