Medevac quicker then ground? Not getting out for Trauma?

[Guest alsfirefighter]

I was just wondering if there is anyone else out there who actually had to make a decision to use a medevac because you honestly believed that they would arrive faster then getting a ground ambulance? Granted it was a critical trauma and also well within medevac guidelines...but one that I normally would not fly out and would immediately initiate ground transport for.

Also does anyone remember when certain trauma calls for VAC's were the equivalent of the dispatch of a confirmed working structure fire for the volunteer fire service? When do you admit there might be a problem when you don't get out for calls like that? "That's what we have mutual aid for." Really...then why after 4 agencies being toned a minimum of 2 times each does someone get there?

Also does anyone have any policies to deal with personnel who take part in dual role or agency activities? When do you take on the problem of someone choosing one versus the other? Say like you have a penetrating trauma call...and when you finally arrive at the LZ with your mutual aid bus..you see known VAC members standing at the LZ....when is that even a ethical issue to some?

Enough venting I guess...let's see what others think.

[INIT915 1,119]

Tom-

You took the words right out of my mouth. As I had to go in early today to handle the investigation related to the call your referring to, I had the same thoughts you did.

I can remember back to when the 3:30 a.m. nursing home fall couldn't muster a crew, but never the roll-over, the structure fire, the shooting, etc, etc.

This morning's incident seriously made me think we have "crossed the line."

[Guest alsfirefighter]

Bro...I know we have known each other and have been very close personal friends for a number of years but I thank you for that reply. At least I know I'm not off my rocker or off base for my thoughts on it. I didn't know you were coming in to handle the investigation or I would have came back to say hello. Speaking of which I was talking to one of the Sgt.'s that was on scene this am (I won't tell you where or how we ran into each other, lol) but if you can PM me I don't know if I still have a valid email address for you and I'd like to be able to talk to you about the call (I know you've been there as well) and I want to make sure the info I gave the Sgt. this AM got to you. I guess I read my thoughts and concern on my face more then I think as I was trying to stay close to the cuff due to some of the parties that were still inside making comments about the length of time I was there...but I guess in some way it must have as you know about it.

PM me when you get the chance.

[Mofire24 27]

Tommy

that has been going on for along time and I saw that alot but some people thought I was out of my mind it's picking and choosing calls because they have to be at that great call instead of all of the calls minor or serious

[INIT915 1,119]

Tommy

that has been going on for along time and I saw that alot but some people thought I was out of my mind it's picking and choosing calls because they have to be at that great call instead of all of the calls minor or serious

I think that was Tommy's (and my point). Picking and choosing, age old problem. But now, a rig can't get out for a signifcant trauma/StatFLight job? That's a sign things have gotten very bad.

Picking and choosing has always been wrong, but let's face it, it was a fact. The fact that an ambulance didn't arrive on this scene for as long as it did, and StatFlight had to be considered as a primary transport vehicle, I'm not even sure what to say! I'm almost speechless.

[99subi 121]

Paid EMS. its needed.people need to wake up.

[Goose 188]

Paid EMS. its needed.people need to wake up.

Take it a step further, a county wide EMS system is what is needed. Period. The elected officials know it's needed, i am convinced of that but they don't want to tackle the issue - maybe because it would cost too much or maybe because its a political hot potato (remember, volunteers vote too).

The point is, and i appreciate Tom starting this thread, is that the "line" that INIT95 is referring to has been crossed over and exceeded by a few hundred miles. People are just not getting out for anything, not even hot jobs. I am confident people have died or have suffered because of this.

But, nothing is going to change. Not until the residents of Westchester who are paying out the rear end in taxes realize or are brutally educated as to the reality on the ground. I had a volunteer once tell me that a particular community (happens to be an affluent neighborhood in Westchester) could never afford career EMS - i called them on the BS immediately. I said forgo a few cups of starbucks a year and you've paid for a potential ambulance tax. Add 2 or 3 bucks onto tickets (parking, speeding, etc) and you can lower it even more.

I've never been in the situation you've been in, Tom, i frankly hope i never have to (but i know you can hold it down and that patient probably owes their life/well being to you). However, i can recall one job i did during a snow storm where i was dispatched (in a system where it was me and the ambulance only) for a fall. Got on scene, made an assessment - it was an uncomplicated ankle fracture, no significant trauma, no complicating factors. BLS job straight from the text book. I waited through an hour and half of paging, called up the dispatch center and told them to just send the medic. I had to take the medic out of service to drive me to the hospital because no one was coming out. It is a horrible feeling, even with a stable patient, to have to explain to them why they had to wait an hour and a half before we could leave.

Point is, the system is a total failure and a failed system is simply dangerous. Eventually someone "important" is going to be on the receiving end - thats when your going to see a whole lot of change real quick.

Edited April 11, 2009 by Goose

[ckroll 101]

Enough venting I guess...let's see what others think.

And I haven't a clue what the call was about.... In a perfect world every call gets answered, and right away. System management, and there have been papers written on the topic, tries to get most of the calls covered appropriately, most of the time. A system designed where there are NEVER any calls that go bad is a system that may be overstaffed. And anytime 'Volunteer' is part of the equation, well..... we get what we pay for.

And that said,-- what about the patients? If what we do has deep personal significance, then getting there most of the time may be good enough for bean counters, but someone, all of us, need to speak up and say most of the time isn't good enough. I chose EMS before paramedics were an option, where time to definitive care meant 30 scary minutes in the back of an ambulance with not much more than good intentions and good rubber, hoping there was time to make the Medical Center. The ability to transport was all we had. .... and without it we don't have anything.

Take it to the persons who have responsibility, the town, the city. If a patient has been failed by the system, then the system needs to be changed. Then we need to look at what it will cost to change the system. It sounds like there needs to be serious discussion over what we need and what it will cost.

Good topic.

[Mofire24 27]

The volunteer EMS system as a whole is circling the drain

[x134 46]

Tommy, We .....AFD recently had a serious mva on rt 55 almost to the town line and it was a difficult and lengthy extrication / disentanglement. The Paramedic on duty called for a Helicopter........ yes, I said a Helicopter in Arlington. A few people that I ran into asked why we called a Helicopter and said, ''you are so close to ST. FRANCIS''. It took the guys 45 minutes to get the patient out because of the condition of the vehicle and the difficult spot it was in and he had some pretty good trauma. The Helicopter was on the ground in AFD before extrication was completed. Some say that we are only 8 to 10 minutes from a level 2 trauma. In another 5 minutes the patient was at a level 1 and into surgery. I THINK OUR GUYS DID THE RIGHT THING!

The week before we called a Helicopter for and elderly female burned in a house fire off Vassar Road. Not quicker, but at the right Hospital..... in my opinion. Pictures of accident and fire at www.local2393.com

Edited April 11, 2009 by x134

[Remember585 815]

Two things.

1. My opinions are mine and mine alone, which do not reflect on any affiliations I have.

2. I am not talking about any specific incidents or organizations so nobody should take it personally.

I was just wondering if there is anyone else out there who actually had to make a decision to use a medevac because you honestly believed that they would arrive faster then getting a ground ambulance? Granted it was a critical trauma and also well within medevac guidelines...but one that I normally would not fly out and would immediately initiate ground transport for.

Last year we had an MVA in the south east part of our district in the Town of Cortlandt. I arrived first, finding a car split in half with one still in it. I requested STAT on standby pending medical evaluation. ALS arrived and asked for us to launch the bird. Her reasoning was that we were 5-8 minutes from any major roads, that it would take a total of 20-25 minutes to get to WMC and we had to do a bried disentanglement and extrication to get him out of the wreck. He was stable enough to go by ground, but because we already had them on Standby and were out of the way she felt it would be faster to fly him.

Also does anyone remember when certain trauma calls for VAC's were the equivalent of the dispatch of a confirmed working structure fire for the volunteer fire service? When do you admit there might be a problem when you don't get out for calls like that? "That's what we have mutual aid for." Really...then why after 4 agencies being toned a minimum of 2 times each does someone get there?

Tommy, it isn't just traumas anymore. I've heard calls for a woman in labor that don't get covered. In one case I remember, the PD made a delivery and waited for the ambulance to show up. One other case I remember the Mutual Aid showed up and had the woman in the back of the rig, was heading off to the ED and she popped.

Also does anyone have any policies to deal with personnel who take part in dual role or agency activities? When do you take on the problem of someone choosing one versus the other? Say like you have a penetrating trauma call...and when you finally arrive at the LZ with your mutual aid bus..you see known VAC members standing at the LZ....when is that even a ethical issue to some?

We just split EMS from the FD less then a year ago. I haven't seen any issues yet. We've had guys at the call with FD that are members of EMS who "change hats" and assist EMS either as a driver or another EMT. Heck, one day we had an MVA and EMS was out the door responding, so I asked the EMS Lieutenant if he could drive our Rescue (which he is qualified on being a member of FD). We're all there for one reason - TO HELP THOSE IN NEED! If you've got an incident like you speak of and people show up with FD that are members of EMS and don't help out, then they should be ashamed of themselves! Go ahead and hate me people, but it's true. If your ego is too big to take off your turnout coat and drive an ambulance (assuming you're qualified to do so) then go home. WHO ARE YOU REALLY HELPING? We used to have the same problems here when FD did EMS. Guys would straight up refuse to help out the Ambulance because they were there with the FD. I probably said it once or twice myself. But in today's age of diminishing personnel and those with stopwatches & lawyers, we've got to use our heads! What if the patient DIES? I bet that story won't be on the department website and nobody will be wearing a shiny new Life Save award!

Enough venting I guess...let's see what others think.

You bring up a perfectly legitimate subject and one that is worth discussing. I think this subject can be discussed in depth without having to cite specific incidents, so let's see how it goes!

[Guest alsfirefighter]

I appreciate the discussion my thread has generated and after reading a couple of them I wanted to point a few things out on my own as well.

I have no issue with calling for the medevac with the exception that I for a significant matter of time, thought that it was the only option to ensure that I got my patient to the hospital. That mean I made that decision based on I had no ambulances coming...or assembling for that matter when I made the decision that I was going to use whatever vehicle on scene to get the patient to the LZ to get them to the trauma center.

585..I generally do not as habit criticize anyone who uses a medevac in an instance where I generally would have not. The job that you speak of the provider sounds like they ran the scenario through their head to make an informed decision based on what they deemed to be. If I had an ambulance I would have ground transported the patient to the medical center and would have even saved a few minutes of time. My original ETA was 13 minutes (well you know it was 30..but that was because of a mis-spelling)....I don't know what the actual time was, but I believe it may have been closer to actual 15 mins. Either way take that 13 min. flight time...that's 26 minutes approximately...couple in the time you have to report to the flight crew...have them hook their stuff up...get the patient on their stretcher...then get to the helo...load the patient, plus the time they are still on the ground....and chances are you will be about the same if not slightly faster in our region. We are just inside the cuff of actually saving time.

x134...kind of along the lines of what I said to 585...that patient was going nowhere but the level 1 trauma center as a level 2 isn't even an option for me anymore. The only time the thought of going to Hudson Valley Hospital was in my head was when I was first told I could be waiting 30 minutes for a medevac and all I had out front were cop cars, a flycar and a FD BLSFR vehicle. The request for the medevac was well within protocol and guidelines for use of medevac. But I do not feel that my decision had to be based on I needed an ambulance and the helo was the only option I had at that particular moment. And as another comment showed, I was the only emergency services professional on the scene to notice what was going on...and also so did civilians.

[DR104 141]

Tommy

that has been going on for along time and I saw that alot but some people thought I was out of my mind it's picking and choosing calls because they have to be at that great call instead of all of the calls minor or serious

Thats why it called volunteer!!!and it sucks for the ones that go to all the calls and make all the training!!! And what if that one person keeps showing up and nobody else they themself will just give up and stop going to calls.How about if they just tone out for a call with no info about it and when they get to the vac then you find out the info for the call. So you do not have your picking and choosing!! (and no buffs buffing the call) LOL

[Bnechis 3,961]

Paid EMS. its needed.people need to wake up.

So you need paid EMS if volunteer EMS can't get a proper crew on the road, doesn't that also mean that the communities that can't get a proper fire crew on the road should also go paid? I know a lot of agencies that would fight this, even if it is what is happening all over.

[99subi 121]

So you need paid EMS if volunteer EMS can't get a proper crew on the road, doesn't that also mean that the communities that can't get a proper fire crew on the road should also go paid? I know a lot of agencies that would fight this, even if it is what is happening all over.

Not at all. We have Career as well as volly FF's. a truck always gets out and we always have manpower for the most part

[Bnechis 3,961]

Take it a step further, a county wide EMS system is what is needed. Period. The elected officials know it's needed, i am convinced of that but they don't want to tackle the issue - maybe because it would cost too much or maybe because its a political hot potato (remember, volunteers vote too).

I agree that regional (maybe countywide, or larger) is what is needed. When you say the elected officials know it but wont tackle it is not quite acurate. The City's and some Towns are providing quality service and the officials do not see a need to change. The County Elected officials have no responsability to provide it (EMS is not mandated & the locals are providing it, or atleast claiming they are) and they will never stick their political necks out. The Town officials are the ones who need to put their foot down and consolidate the multiple agencies within each town and then figure out a method to staff them. This will not happen because of the politics and the towns have no $$$. The best chance of this happening is for the agencies themselves to work together and if that is not enough go to the town as a group and tell the truth; "WE CAN NO LONGER COVER AND WE NEED HELP" until this happens nothing is going to change. I think it would also help if FD, PD and ALSFR agencies documented and reported when the amulances do not get out. The problem is who does it get reported to, assuming it can be reported without creating other issues.

But, nothing is going to change. Not until the residents of Westchester who are paying out the rear end in taxes realize or are brutally educated as to the reality on the ground. I had a volunteer once tell me that a particular community (happens to be an affluent neighborhood in Westchester) could never afford career EMS - i called them on the BS immediately.

Since more than 60% (or more) of the residence are covered by paid systems or believe they are paying for service most residence assume they are covered. When you drive past the VAC or the fire station and see lots of expensive vehicles, "I must be covered, right?"

I know what it is costing many of the VAC's to maintain a single perdiem medic slot, and I question the wisdom of the level of spending for perdiem staff to be paid peanuts and sleep instead of consolidation and full time employees (see thread on EMS pay). While the community can "afford it" should they pay for it like this? Unless they have really priced it out, the agencies that claim they can not afford it are just using $$$ as an excuse not to produce.

I've never been in the situation you've been in, Tom, i frankly hope i never have to.

It sucks. As a flycar medic I had to transport an infant with mom bagging the tubed patient (she was an RN) as she sat in the front seat with her son on her lap & I drove the flycar to the ER. The volunteer BLS could not get a crew & 2 mutual aid calls did no better. I laid it out to mom and she agreed it was best.

Point is, the system is a total failure and a failed system is simply dangerous. Eventually someone "important" is going to be on the receiving end - thats when your going to see a whole lot of change real quick.

Point is in many communities it has never been a system.

I dont see it changing very quick, unless NYS DOH steps in and says: "if you can't get out 24/7 you lose your CON" then the community will have no ambulance and the town/village will be forced into something.

[Bnechis 3,961]

Not at all. We have Career as well as volly FF's. a truck always gets out and we always have manpower for the most part

I was not refering to your dept. (I don't even know which dept. you are from). But you can hear it all the time around the county.

Also you may want to reword your statement: "Always" and "for the most part" dont work in the same sentence.