Tag Archives: emergency medical services

Bagram airfield a leading lab for trauma medicine

NPR’s Quil Lawrence reports that Afghanistan’s Bagram airfield, the primary stop for seriously wounded soldiers before they’re stabilized and transported to Germany or America for long-term care, has served as an opportunity for forging broad advances in emergency medicine.

“At the beginning of this conflict, we were taking the best trauma medicine from the civilian sector, and we brought it to Iraq and Afghanistan,” says U.S. Air Force Col. Chris Benjamin, the hospital commander. He says now his doctors tell him it’s the other way around.

“Here we are seven, eight years later, taking what we’ve learned in these conflicts to teach them the advances that we’ve made with this data collection here in theater,” he says.

Thanks to body armor and advances in battlefield trauma like the increased use of tourniquets, more soldiers are arriving alive, but with serious, traumatic injuries. When they pass through Bagram, the volume and severity of their wounds “continues to yield new data that are helping to save lives in ways that were impossible only a few years ago,” Lawrence writes.

Why Detroit’s emergency services are lagging

The Detroit News‘ Charlie LeDuff tried to figure out his city’s abysmal ambulance response times, and had a tough time finding excuses for why they are so far behind the national average, though staffing cuts and budget shortages certainly played a role. He wears his frustration on his sleeve and the article’s brutally incisive as a result. I’ll do my best to summarize, but it’s certainly worth a read.

One problem, according to a 2004 city audit of the Emergency Medical Services (EMS) system, is that Detroit is the only major American city that does not allow a firefighter or a police officer to aid a victim before the ambulance arrives. Another problem is substandard communication equipment. Since that report was issued, at least two hospitals have closed and the EMS system has been decimated by staffing cuts causing ambulances to drive farther.

The national standard for ambulance response is eight minutes, and some Detroit suburbs have it down around five. Nobody’s sure how long Detroit ambulances take, but it’s clear that it’s well beyond the acceptable threshold. Fire Commissioner James Mack Jr. said the departments doing the best it can to maximize resources amid budget constraints, LeDuff reports.

Mack made a claim to Fox 2 News a few weeks ago that the average response time in Detroit for an ambulance to arrive on a 911 call is 12 minutes — even while admitting that often there are no units available to get to calls.

According to that 2004 audit, the two-year average at that time was about 12 minutes. And that was before the city cut its paramedics and emergency medical technicians by nearly 40 percent.

Assessing acute care in America

The New York Times‘ Kevin Sack reports on a Health Affairs study that explores “acute medical care,” particularly initial visits for the fever and cough type of stuff that would traditionally go to a primary care physician. While 42 percent of such visits were still handled by a patient’s personal physician, a full 28 percent took place in emergency rooms. According to Sack, that number includes almost all visits made outside of typical office hours, as well as most visits made by patients without insurance.acute1

More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy. Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.

Reform provisions such as medical homes, accountable care organizations and more money for primary care seek to rebalance acute care delivery in the United States, but Sack reports that the study’s authors fear it won’t be enough.

The authors warn that it might not be enough. “If history is any guide, things might not go as planned,” they wrote. “If primary care lags behind rising demand, patients will seek care elsewhere.”

Remember, free access to Health Affairs is one of many perks enjoyed by AHCJ members.

NTSB webcasting air ambulance safety hearing

Today the National Transportation Safety Board opened a four-day public hearing on the safety of helicopter emergency medical services operations. The NTSB is webcasting the hearing.

Through Friday, the NTSB will hear from technical experts about helicopter EMS operations, with the goal of better evaluating the factors that lead to accidents. Most witnesses will participate as part of small panels addressing particular safety issues.

(Photo by euthman via Flickr)

(Photo by euthman via Flickr)

The witnesses will include including pilots, medical personnel, managers and Federal Aviation Administration officials who provide oversight. The board has posted an entire agenda and documents related to the proceedings.

In January 2006, the board issued a special investigation report on EMS operations. Many of the 55 EMS-related aviation accidents (fatal and non-fatal) that occurred between January 2002 and January 2005 could have been prevented with simple corrective actions, including oversight, flight risk evaluations, improved dispatch procedures, and the incorporation of available technologies, according to the NTSB.

The board issued four safety recommendations to the FAA but have not yet been fully implemented. Over the past 12 months, the board has investigated an additional nine fatal EMS accidents, which killed 35 people. The agency added helicopter EMS safety to its Most Wanted List of Transportation Safety Improvements.

The Baltimore Sun reported last year about air ambulance problems in Maryland and found that nationwide since 2003, many of the 26 fatal air ambulance crashes didn’t involve life or death missions.

A search for air ambulance crashes in the online version of the NTSB database is tricky. The search form doesn’t include the category, but typing in the box titled “Enter your word string below” will return records on the search terms “%air ambulance%” . The “%” is the wildcard symbol in the NTSB database. The search can also be limited by dates, state and other elements. Caution: Wildcard searches are notorious for picking up false matches. Check your results carefully.