March 2004 Letters

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Mail: EMS, 7626 Densmore Ave.
Van Nuys, CA 91406-2042
E-mail: emseditor@aol.com

Airing Grievances

I am writing in response to Dr. Bledsoe's August EMS Mythology column (EMS Myth #6: Air Medical Helicopters Save Lives and Are Cost-Effective). In a rare occurrence, I agree with Dr. Bledsoe in some aspects.

Here in Montgomery County, PA, we have only one trauma center for the entire county. Pennsylvania has some of the worst insurance problems in the U.S. With skyrocketing costs and astronomical settlements for the littlest medical mistakes, even the largest city hospitals are no longer able to provide trauma service. One of the finest hospitals in the world, Hahnemann University Hospital, recently stopped accepting trauma patients. Compounding this problem is the fact that even if it were accepting trauma, Hahnemann and all the other closest trauma centers are still too far away to be a reasonable option for transport.

The two local hospitals I work with, however, are so overworked and afraid of liability that they fly basically anything non-medical out by helicopter. In this respect, Dr. Bledsoe hits dead center on this issue. Imagine flying a patient who has ankle pain after tripping from a standing position onto the soft ground. No loss of consciousness, no other complaints but ankle pain. There is a realistic possibility that the hospitals within 10 minutes of the community I serve would deny my crew entrance to their facility and order the patient to be flown by chopper to Philadelphia.

I assert that the main reasons for helicopter service overuse in this area are the rising cost of medical malpractice insurance and simple laziness on the part of medical command. In the instance of inclement weather, with local hospitals not accepting ankle pain, we are forced to drive an hour to the nearest trauma center. Would anyone find that reasonable? I know personnel who have taken to simply not contacting the hospitals themselves, out of fear that the smallest misspoken word would force a 2½-hour out-of-service time for a simple motor vehicle collision. Would anyone find that reasonable?

In closing, I agree with Dr. Bledsoe's article in some aspects, but I believe the overuse of helicopter service is due to in-hospital problems, rather than the failure of EMS on the scene.

Tim McAteer, NREMT-P
via e-mail

Bryan Bledsoe, DO, FACEP, EMT-P, replies: Thanks for the note. I agree that there are multiple reasons why medical helicopters are overutilized. Rising malpractice premiums and lack of tort reform have driven some physicians from practice, leaving hospitals and trauma centers with some specialty areas uncovered. This is but one of many factors affecting the issue of helicopter overuse. Helicopters are an important part of EMS and must be managed like any other costly commodity. There are medical helicopter services in the Midwest signing subscriptions to offer primary responses to customers' residences-this bypasses the established EMS system. Helicopter operations and EMS must agree upon objective (that is, non-political) criteria in order to determine which patients most benefit from helicopters.

More worrisome in your letter is your statement, "There is a realistic possibility that the hospitals within 10 minutes of the community I serve would deny my crew entrance to their facility and order the patient to be flown by chopper to Philadelphia." If these hospitals did this, they would violate numerous federal and state laws. Not only the hospital, but the physicians could face daunting monetary penalties. I hope this is not the case-but if it becomes so, you have a duty to report this to the appropriate state and federal authorities.

In response to the last paragraph of your letter, I fail to see how "in-hospital problems" cause overuse of medical helicopters. Who calls for the helicopter? Is it the EMS crew on the scene or the physician at the hospital? That is where the problem is.

One last point: The goal of the EMS Mythology series was to stimulate discussion and critical thinking. I never wanted everybody to agree with me-in fact, I wanted them to disagree with me. There were parts of the series that I didn't personally agree with-but I presented what the literature said. Thus, as evidenced by this letter, the series got people thinking. That is a good thing.

Unity in Standardization

I am writing in reference to "Who Are You?": The Need for Standardization in EMS in your August issue.

I've been a paramedic since '98 and in EMS since '92. I've worked offshore and in ambulances in three states. On occasion I've driven up on wrecks on the interstate prior to EMS arriving. The standardization of uniforms with color codes would help in identifying the medics at these scenes, and allow bystanders to know who to give a report to when emergency personnel arrive.

There are several national agencies that represent the EMS community in the area of standards. The problem I see is that the people from these agencies need to come together first, then approach FEMA, the Department of Health and Human Services or the Federal Interagency Committee on EMS about a joint effort to standardize EMS.

Through their representatives on Capitol Hill, these agencies can boost our ability to be heard. Once EMS and its federal partners have come together, they should approach lawmakers and present specific ideas for the standardization of EMS. Until we have a community that can speak as one and represent all EMS personnel, the standardization of EMS will never happen. There are so many things a coalition like this could do to help EMS personnel-CEUs that are recognized by the National Registry, standardized training for EMS levels, better pay for our better training, a standardized training level for chemical warfare and mass-casualty incidents like 9/11.

What could readers do to help the cause of standardization in EMS? Or what could I do to start the wheels turning on this idea?

Jonathan Bland, NREMT-P
Dothan, AL

The editor replies: Readers are invited to share their thoughts on this topic. E-mail emseditor@aol.com.

Correction

In the December 2003 issue, there were some inaccuracies in the description of the Hype-Wipe Pull-Pack® from Current Technologies, Inc., in the article titled Best of Show: Part 1 on page 57. The product photo and description was for the Hype-Wipe® Disinfecting Towel with Bleach, not for the Hype-Wipe Pull-Pack®. The correct kill times for Hype-Wipe® bleach towelettes are as follows: one-minute kill for TB and Streptococcus, not the 30 seconds listed. The correct kill times for Staphylococcus and MRSA are two minutes, not the one-minute listed. Hype-Wipes® have no official kill claims for poliovirus, herpes simplex, rotavirus, HIV and hepatitis-A, which were erroneously listed as being killed in one minute. The shelf life for Hype-Wipes® is 12 months and has not been extended to 18 months as described. We apologize for any confusion this may have caused.