Monday, December 22, 2014

Is Mechanism of Injury a Valid Reason to Fly a Patient?

“It’s sort of the perfect storm,” said Dr. Michael Abernethy, chief flight surgeon for University of Wisconsin Health’s Med Flight. “It’s great money, it’s unregulated and there’s really no utilization criteria.” (quoted in The Bulletin, Bend Oregon)

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When we fly a patient who walks out of the hospital hours after arrival, some question the appropriateness of the flight. Then again, there are injuries which cannot be detected in the field, which might prove serious or fatal after some time has elapsed.

In some cases, staff at receiving facilities give helicopter crews a hard time.  "Why did you fly this patient?" asks the overworked and fatigued resident. Few if any cases allow a crew to decide that a patient does not need to be flown after arriving on scene. If first responders call, the patient will fly...

What do you think? Do you have any stories about flights that ended up being appropriate after all?

Here is one anecdote...

Some years ago I flew a mechanism of injury patient who was alert, oriented, and telling us not to make such a fuss over her, she was "fine".

We were only minutes into the flight when she decompensated, she became unresponsive and her belly began to show evidence of internal bleeding.

We were on our way to the "closest trauma center" in Camden, NJ, and upon arrival were unable to land as the pad was occupied by the State Police helicopter, shut down and unmanned delivering a patient the facility.

My crew made the decision to "cross state lines" (if you operate in the Philly area, you will understand that statement) to take her to our trauma center in West Philly (all of a 2-3 minute furthther flight).

We landed at our facility before the helicopter at the original destination had cleared the pad, in fact as I recall, the patient was in the OR, exanguination protocols in effect, by the time the other pad was clear.

Moral of this true story, unless you have a CT scanner available in your A/C or ground unit, perhaps mechanism of injury is not such a bad thing.

For all the naysayers, if this one life was saved for certain by that criteria, how many others have been as well?

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