Bledsoe talks about HEMS.

[Sasha]

This is an old article, but I found it interesting to read. Did a quick search and didn't turn up any results, but if it's been posted previously, I'm sorry.

Alright, I’ll Say It

Full Article: http://www.ems1.com/ems-products/ambulances/articles/404642-Alright-Ill-Say-It/

On May 24, 2008, the National EMS Memorial Service recognized 73 of our brothers and sisters who gave their lives in the line of duty. Interestingly, 37 of those individuals died as a result of a medical aviation accident. Stated another way, nearly 51 percent of the entire memorial is tied to medical aviation incidents. In the last few weeks, we have had four medical helicopter crashes:

Medical helicopters save lives?
There is no discernible scientific evidence that medical helicopters save lives. Let me say that again: There is no scientific evidence that medical helicopters save lives. Even the most rabid helicopter proponent must admit to that. Sure, there are some studies that indicate that a part of the population may benefit (primarily those with an Injury Severity Score [ISS] > 30 or more). But they have to dig deep into questionable statistical analysis to come up with any evidence whatsoever. Many of the studies supportive of helicopter medical transport are frankly a priori. There is no evidence that the interhospital transport of patients improves outcome. The comparative studies show that patients transported by ground do just as well as those transported by air. Most honest trauma surgeons will tell you that, over the course of their career, they can count the number of patients who benefited from helicopter transport on one hand.

We in EMS continue to promote the use of helicopters by not questioning the practice. The actual number of “lives saved” is quite few. But how can you argue with somebody who says, “The helicopter saved my baby” or “My momma would not be alive had it not been for that crew”? When science and emotion cross, it is not a pretty picture. But science, if done correctly, is without bias (or has limited bias). The word “emotion” and “bias” can almost be used interchangeably. We must abandon the emotion and seek the science.

I see flight nurses and flight paramedics as victims. These are great people who took these jobs because they like working on helicopters and they believe they are making society better. They are caught between their dreams and the realities of the job. I have received numerous emails from flight nurses and paramedics. They usually start, “Please don’t use my name or I’ll lose my job. I agree with you. We are transporting more and more non-emergencies. Keep fighting for us.” The job is dangerous — among the most dangerous there is — and although it hurts to hear this, the vast majority of patients will do just as well if transported by ground. We know that on ground EMS calls, we rarely “save lives.” The same holds true for helicopter EMS.

 

[8jimi8]

very interesting. i'll be honest enough to admit that i've never ridden in the helicopter, yet my goal is to work in one. This has definitely brought to light some of the more egotistical reasons for such desires.

 

[VentMedic]

The helicopter companies are also to blame. They know that flying on a medical helicopter is fun and many paramedics would work for free. Some helicopter services in Texas pay paramedics $380 per 24-hour shift and nurses $450 per 24-hour shift. Would you work for the same money if the job was a ground transport unit? As the helicopter fleet has increased, the size of the helicopter has decreased — and in certain conditions, gotten older. There is a lot of peer-pressure in HEMS. There is a shortage of pilots, but no shortage of nurses or paramedics. Dare to say no when two want to go? Sure, it sounds good on paper, but, remember that nurses and paramedics are replaceable — pilots are not. Subconscious coercion exists.

EMS is fun and many do work for free...unfortunately. Even HEMS has gotten to the warm body mentality and use this eagerness to staff their helicopters. They know they have a barrel full of applications to pull from and often salary negotiation is not an option regardless of your credentials. Hiring those with experience would also make it more likely to have deficiencies pointed out about the company.

It is also bad and sad when some well known agencies rely on ground crews who may even be volunteers to accompany them when they use only 1 medical crew member.

 

[muzlblast]

After hearing Bledsoe speak at Clincon a few years ago I believe that for some reason he is very anti- HEMS. For what reason I do not know. However, while every air transport may not be the sole factor that saves someone's life, helicopters most certainly have their place. Rurual locations, remote or unaccessible places, as well as the specialized training helo team members have are are quantifiable benefits to an air EMS program.

Bledsoe seems to have his own agenda in eliminating HEMS altogether. I am highly skeptical of his rationale for this but that is what he seems to aspire to.

As I said I lost all respect for him after hearing him speak at clincon. Feel free to form your own opinions...

 

[VentMedic]

After hearing Bledsoe speak at Clincon a few years ago I believe that for some reason he is very anti- HEMS. For what reason I do not know. However, while every air transport may not be the sole factor that saves someone's life, helicopters most certainly have their place. Rurual locations, remote or unaccessible places, as well as the specialized training helo team members have are are quantifiable benefits to an air EMS program.

Bledsoe seems to have his own agenda in eliminating HEMS altogether. I am highly skeptical of his rationale for this but that is what he seems to aspire to.

As I said I lost all respect for him after hearing him speak at clincon. Feel free to form your own opinions...

Have you done any reading about the crashes that have killed so many medical professionals over the past few years? The life he wants to save is that of the medical professional as well as the patient.

Have you read about the safety issues?

Have you read anything about the use of a helicopter as a personal taxi service for some ground providers or hospitals?

He is not for eliminating helicopters but he doesn't want Paramedics to die needlessly when just a few changes can be implimented to enhance safety and maybe save the lives of the Paramedics on a helicopter.

 

[VentMedic]

Some reading for you:​

http://www.ntsb.gov/Recs/letters/2006/A06_12_15.pdf​

Between January 2002 and January 2005, 55 EMS aircraft accidents occurred in the United States1 (this number of EMS accidents had not been seen since the 1980s);2 these accidents resulted in 54 fatalities and 18 serious injuries. Although the number of flight hoursflown by EMS helicopter operations has increased from about 162,000 in 1991 to an estimated 300,000 in 2005,3 the average accident rate has also increased from 3.53 accidents per 100,000 flight hours between 1992 and 2001 to 4.56 accidents per 100,000 flight hours between 1997 and 2001.​

More at:
http://www.ntsb.gov/aviation/HEMS-links.htm​

​

 

[EMSLaw]

What's the cause of the increased rate of accidents? Is it failure to adequately train pilots and ground crews, or is it crew fatigue, or maintainance issues, or something else entirely?

 

[emtzach03]

What's the cause of the increased rate of accidents? Is it failure to adequately train pilots and ground crews, or is it crew fatigue, or maintainance issues, or something else entirely?

usually mechanical failure plays a role, but at times its pilot/crew error, i used to drive ground transport in worc ma for lifeflight, there program works very well imo because at any time anyone in the flight crew can refuse to fly IE weather, fatigue, ETC. other flight companies are just that a money making company if they dont fly they arent making money.... can u see the problem with that. umass lifeflight has sponsorships and grants and of course a billing department but they would refuse a call rather than risk a flight that another service may take, such as low ceiling poor visability cold temps ETC. this of course is just my opinion of what i have seen

 

[muzlblast]

Have you done any reading about the crashes that have killed so many medical professionals over the past few years? The life he wants to save is that of the medical professional as well as the patient.

Have you read about the safety issues?

Have you read anything about the use of a helicopter as a personal taxi service for some ground providers or hospitals?

He is not for eliminating helicopters but he doesn't want Paramedics to die needlessly when just a few changes can be implimented to enhance safety and maybe save the lives of the Paramedics on a helicopter.

Yes I have seen the data. I have also seen him speak in person. As I said, feel free to form your own opinions. I have formed mine. I am a helicopter medic. I've been on the flights. I've seen BS and I've seen people who have benefitted greatly from being flown as opposed to going by ground. I'm not a Bledsoe worshipper and think his time would be better spent worrying about his patients as opposed to their method of transport. Thats what the FAA is for.

 

[muzlblast]

Primary causes of HEMS accidents are CFIT ( controlled Flight Into Terrain) or operating in IMC, Inadvertant ( Instrument Meteorlogical Conditions) and spatial disorientation and or disorientation by crew members during night operations. We need to improve safety through increased pilot/ crew training with instrumetntation and night vision capabilities. Not as Bledsoe says by eliminating HEMS as an option.

Many people are needlessly transported every year by ambulance. Should we just reduce the number of ambulances and stop responding to BS calls? The ambulance, as well as the helicopter is there for when it is appropriately needed. However just like the ambulance there will be times when it is used inappropriately. Getting rid of them as Bledsoe would seem to want (at least when I heard him speak) is not the answer. More oversight by the FAA involving training and operation as opposed to just airworthiness inspection is what is needed.


Being a doctor does not make one an aviation expert.

 

[MSDeltaFlt]

What's the cause of the increased rate of accidents? Is it failure to adequately train pilots and ground crews, or is it crew fatigue, or maintainance issues, or something else entirely?

The cause is quite simple. It is choice. The crews on the aircraft make poor choices, small insignificant ones at first glance, but the result is still the same. Those choices end up drilling the crews into the ground like lawn darts.

 

[VentMedic]

Being a doctor does not make one an aviation expert.

So what's you point?

Do you think those of us involved in flight are just whining?

If Bledsoe's voice can make a difference for safety and improved field/hospital triage, then why not?

Are you involved in flight to even know the issues?

Getting rid of them as Bledsoe would seem to want (at least when I heard him speak) is not the answer.

These are YOUR words or YOUR interpretation. In his article posted by the OP and on other forums he talks about overuse...NOT elimination.

 

[EMSLaw]

Primary causes of HEMS accidents are CFIT ( controlled Flight Into Terrain) or operating in IMC, Inadvertant ( Instrument Meteorlogical Conditions) and spatial disorientation and or disorientation by crew members during night operations.

Controlled Flight Into Terrain? To paraphrase George Carlin, that sounds supiciously like flying into the ground to me.

I'd be curious to know how HEMS safety record in general compares to similar types of aviation - but the only thing I can think of is military rescue helicopters, and I'm not sure that's even a good comparison. If (and I don't know this is true) the military manages an excellent safety record while flying in all weather, while HEMS manages a mediocre record flying only in good weather, then shouldn't we be asking what training and operational changes will make civilian flight better? Heck, shouldn't we be asking that question anyway?

 

[atropine]

Bledsoe has good heart, but nothing will change the all mighty dollar rules. Just like SSM is cheap for private companies and makes no sense at all, HEMS can't charge if they don't fly simple as that.

 

[muzlblast]

So what's you point?

Do you think those of us involved in flight are just whining?

If Bledsoe's voice can make a difference for safety and improved field/hospital triage, then why not?

Are you involved in flight to even know the issues?



These are YOUR words or YOUR interpretation. In his article posted by the OP and on other forums he talks about overuse...NOT elimination.

Umm yes I am involved in flight. Don't get offended because I don't agree with Bledsoe. If youn read his article his main premise is that there is no benefit to HEMS regarding patient outcome. I also sat through his presentation in which he stated the same. Helicopter transport is a valuable resource and should be used accordingly. The problem however is NOT with overuse it is with lack of training, VFR with no instrumentation and too little oversight by the FAA. This is not an issue for doctors to be addressing. It is more appropriately dealt with by the the FAA inplementing regulations that will improve the knowledge and training of the flight crews. The FAA doesn't even currently consider EMS personnel as bona fide flight crew. Actual aircraft crewmember training is currently lacking.

We need to be flying instrument equipped aircraft with instrument rated pilots and using NVG's on night ops as well as utilizing TAWS.

So yes I do believe I know what I'm talking about. Bledoe is a doctor, not an aviation expert. Form your own opinion instead of bagging on mine.

 

[VentMedic]

Umm yes I am involved in flight. Don't get offended because I don't agree with Bledsoe. If youn read his article his main premise is that there is no benefit to HEMS regarding patient outcome. I also sat through his presentation in which he stated the same. Helicopter transport is a valuable resource and should be used accordingly. The problem however is NOT with overuse it is with lack of training, VFR with no instrumentation and too little oversight by the FAA. This is not an issue for doctors to be addressing. It is more appropriately dealt with by the the FAA inplementing regulations that will improve the knowledge and training of the flight crews. The FAA doesn't even currently consider EMS personnel as bona fide flight crew. Actual aircraft crewmember training is currently lacking.

We need to be flying instrument equipped aircraft with instrument rated pilots and using NVG's on night ops as well as utilizing TAWS.

So yes I do believe I know what I'm talking about. Bledoe is a doctor, not an aviation expert. Form your own opinion instead of bagging on mine.

Bledsoe mentioned all of that and much more which I believe you may have taken from the lecture you attended or from the article by him in this thread.

 

[zmedic]

Let's say hypothetically helos provided no benefit to patients. Would the helicopter pilots/flight medics/ helo companies ever come out and say "hey, we should just quit because this doesn't work?" No, they all do the job they are doing because they enjoy it, believe in it, and make money off of it. Which is fine. But the aviation community isn't going to look critically enough at itself to ever decide that it isn't needed. Similary, the FAA is tasked with making flights safer, but it's not their job to determine if medical flights save lives, and if so in what situations. That sort of thing is best done by EMS research professionals.

It also is going to come down to a matter of cost. Even if you say "helos have saved lives" the question is how many people you have to fly to save a life. We might get to the point in our medical system where if you have to spend $500,000 worth of flights to save one life it won't be worth it.

 

[BLSBoy]

I'm gonna go against Bledsoe on this one.
Having worked in the dispatch room of a Central Florida HEMS agency, I saw the abuse, misuse and the good that the aircraft provided.
STEMIs from small, rinkydink "hospitals" where the interventions of the flight crew were sometimes better then those the docs did, flying into rural areas to "ER"s and picking up Jethros that walked into the ER missing digits, limbs etc, and bringing them to a Level II or greater Trauma Center, so they can be reattached, and Jethro can continue pickin his banjo.
I also saw the fear that EMS crews had when it came to multi system trauma, and the flew the pt out..... from FIVE MILES AWAY.

Part of the problem is Docs from outlying facilities thinking the aircraft is their own personal shuttle service for their pts, regardless of their status, and the inadequetly trained EMS crews who shovel pts who they are afraid to treat.

I have turned care over to a Flight Crew on only ONE of my pts, and I didn't even want to. He was stable enough he could have been grounded to the Trauma Center, but BLS already had an aircraft inbound, and it was 5 min away, and it was 20-30 min to trauma center. :glare:

Once again, this is an education issue, and an equipment issue.
Ground EMS is not educated enough as to know when to call for an aircraft, and the aircraft do not have 2 pilots, NVGs and proper instruments.

That being said, my career goal is to end up on an aircraft, so I am not totally anti HEMS. Just anti HEMS abuse.

 

[reaper]

FL has some of the greatest "scene" abuse of HEMS. Almost any where in the state you are within 30-45 minute of a level I or II. Very, very small amount of trauma Pt's in that state ever need a HEMS.

A lot of this stems from the HEMS companies taking the abuse, for profit. I have only seen one flight service ever turn down flights, because of BS. That was Shandscare. They still held to requirements for flight and have turned flights down, after landing on scene.

More companies need to start this trend and the abuse will drop dramatically!

 

[BLSBoy]

Reaper, the aircraft I dispatched routinely checked weather before lifting off, and anyone on the aircraft could, at anytime, decline the flight for whatever reason.
"Sterile Cockpit" was heavily enforced, and flights were turned down due to weather.
The aircraft has gone to other hospitals that were further away, rather then the "home" hospital due to weather.
I am a bit biased, but we were extremely safety conscious. There was an aircraft crash many years before I got there, and that lead to many of the safety plans.