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Old 03-08-2009, 02:22 AM   #1
bdubb
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Trackside medics

Everyone please don't jump to conclusions on what I am saying here, but it sounds like life flight is used on trackdays when it isn't always called for. I understand the worries over a head injury or a fracture in a place where bleeding is a major concern.

I just have this feeling that maybe the medics paid to be at the track should do more than call in a $15k helicopter ride.

I do hope that if, and when, I am in need that they make the best judgement they can and to the safest possibility. Be it life flight, or a bandaid.


I would like to hear from Dustin, Matt, and others about their opinions on this as they have been in the riders position themselves.


Am I looking at this wrong, or is the trackside medic crew doing little more than addressing a situation and calling someone else in to take care of it?
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Old 03-08-2009, 02:30 AM   #2
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As an ex medic it sounds like they are useing it as an out to not work
Most of those crews are transport crews and don't handle regular emergencies so a bike wreck freaks them out and the injurys are not there regular strokes and heart attacks so it throws them off and the don't know how to react so to them yes the heli is needed but a well rounded medic it might not be needed
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Old 03-08-2009, 07:32 AM   #3
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When I broke my collarbone, the medics wanted to call life flight and take me to Herman because they didn't like the hospital in Angleton. That sounded like BS to me. Since weather had grounded life flight they transported me to Angleton. Since Angleton is much closer, that was better to me since I could get back to the track much easier. Like you I've wondered what the real story is.
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Old 03-08-2009, 07:43 AM   #4
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Gents, as a current medic. The reason behind the seemingly offhand calling of Life Flight(or helo transport) may be due to the services protocol. If someone would PM me the name of the Ambulance service I can find out and let you know. I do tend to agree with the basic premise that Life Flight is over used, it happens way too often out on the streets too, makes me think that the crops of medics that have come about since Texas went to NR( and its not the only thing that leads me to believe this) is that they ARE NOT prepared for being a medic, they seem to have lack of knowledge and skills as well as confidence. I have a question too, do any of the tracks have a staff medic? or do they just contract it out?
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Old 03-08-2009, 08:39 AM   #5
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Does anybody know if the medics on staff at MSRH this weekend were from Danbury? If so, one of them lives across the street from me, and I can go ask him what their procedures call for.
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Old 03-08-2009, 09:28 AM   #6
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It's really simple to me. Most of the medics contracted by the track to work these events are from private transport companies and are rarely 911 services. The medics at OHR are 911 service and contract transport, Cresson's medics are the City's first responders, and TWS (Texas World Speedway) contracts with off-duty first responders to work their events with a private transport ambulance- they are the exception. Every other track I can think of contracts with private or volunteer EMS. A lot of time, they contract to have only 2 EMT-B and NO paramedics. With LSTD, our contract specifies paramedics- YMMV with another track day provider.

With examples I have witnessed, the flights I thought were un-necessary were due to a lack of experience and knowledge by the medics. They often will fall back on "it's our protocol" but that is complete and total BS and a copout.

Now, bake your brain on this: I have personally witnessed and know of examples where people have refused treatment/ transport, went home and died hours later from a slow bleed in the head. It happens.

Best bet is to use common sense. In the example above about the collar bone and not wanting to use a local hospital, I would have simply refused transport, especially if air medical was the transport mode! On the flip of this, if I crashed and had a concussion and/ or was disoriented for a long time after the crash, and ER visit is mandatory! Air medical transport to me is only to transport to a level 1 trauma center and should be used accordingly. A concussion is not "level 1". Any level 3 hospital can handle that effectively.

Again, experience is the key. While I agree with JP on his NR comments to an extent, it's also the responsibility of the service to TRAIN those folks when they get hired with an experienced/ strong medic!

As long as you are awake, alert, and oriented to person/ place/ time, you can refuse medical treatment/ transport! Use your best judgment. The flip side of this are the people that use ambulances for transport when it's unnecessary too- IMHO, you don't need to go to the ER, let alone by ambulance, for a broken collar bone. When you get there and get seen, you will be told to make an appointment with your MD/ Ortho, thanks for your money, see you later. Waste of time, resources, and MONEY.

At our track days, we have Paramedics on staff that work for 911 services with 20 plus years experience. Our staff doesn't dictate patient care and let the contracted (by the track) medics do their job, but have played a part in helping with transport decisions, especially with unnecessary air medical transport decisions.
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Old 03-08-2009, 09:44 AM   #7
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i think in this sue happy enviroment we have most services are trying to cover their . better over done than under done.
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Old 03-08-2009, 09:52 AM   #8
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i think in this sue happy enviroment we have most services are trying to cover their . better over done than under done.
That's a great theory. It works only in theory though; here's why.

There are cases (lots of them) where insurance companies are suing providers for over-treatment. Insurance companies are also refusing to pay for over-treatment and sending the charges on to the patient, then the patient sues the provider for the fees.

Air medical is not a cheap thing, for a 20 minute flight, they charge around $2500 just for the flight, and that includes no treatment. Charges can easily top $10k as a starter.

I'm not sure what this situation was that is referenced here, but if it's what I'm thinking, I have a hard time believing that the injuries are what is claimed... whatever.
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Old 03-08-2009, 03:53 PM   #9
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undertrained, scared, don't know what to do....I can tell you this though....if I'm conscious, my life is not threatened, and I am aware of my surroundings, life flight won't be an option. I got enough bills already.
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Old 03-08-2009, 04:00 PM   #10
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i would be curious to see the list of injuries that had a life flight requested, and the transport time to a level 3 trauma center and transport time to level 1 trauma center.
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Old 03-08-2009, 04:56 PM   #11
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Quote:
Originally Posted by tomLSTD View Post

I'm not sure what this situation was that is referenced here, but if it's what I'm thinking, I have a hard time believing that the injuries are what is claimed... whatever.
I am not trying to reference any particular incident here. Just seeing what other peoples thoughts are on something I have been thinking about myself.

I agree with some post here, that better safe than sorry. However some common thinking skills are needed too before not only calling in life flight for an expensive flight while also pulling that crew and transport away from someone who may have a serious life or death situation happening.
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Old 03-08-2009, 04:57 PM   #12
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IMHO, you don't need to go to the ER, let alone by ambulance, for a broken collar bone. When you get there and get seen, you will be told to make an appointment with your MD/ Ortho, thanks for your money, see you later. Waste of time, resources, and MONEY.
Not true. They also gave me a sling to take with me for my $3800 charge. Then I went and bought a better one at Walgreen's for $12.

In all seriousness, I agree with you completely.
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Old 03-08-2009, 08:05 PM   #13
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Not true. They also gave me a sling to take with me for my $3800 charge. Then I went and bought a better one at Walgreen's for $12.

In all seriousness, I agree with you completely.
Sitting here in the comfort of my recliner and with perfect hindsight, I would have driven myself to the emergency room. But at the time, even though I thought I was was thinking clearly, and I was, I could not be sure there was not a head injury or some internal damage. Getting directions and driving to a hospital I'd never been to or driving 25 miles to one in Houston would not have been smart. Getting checked out by a doctor is the most sane choice.

As has been written in a different context, leave the ego and testosterone at home. As Tom wrote, many people who thought they were fine have gone home and died soon after. My complaint is not that the ambulance took me off the track or that the EMTs' put me on a back board but that they wanted to call Life Flight for non medical reasons and perhaps political reasons. They didn't like the Angleton hospital and they wanted to see the helicopter. Those of us who get injured are depending on the medical personnel to make reasoned decisions.
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Old 03-08-2009, 10:01 PM   #14
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Originally Posted by texasyankee View Post
As has been written in a different context, leave the ego and testosterone at home. As Tom wrote, many people who thought they were fine have gone home and died soon after. My complaint is not that the ambulance took me off the track or that the EMTs' put me on a back board but that they wanted to call Life Flight for non medical reasons and perhaps political reasons. They didn't like the Angleton hospital and they wanted to see the helicopter. Those of us who get injured are depending on the medical personnel to make reasoned decisions.
You're right; however, there is a lot that has been lost over the years as far as common sense goes. As the saying goes, common sense ain't so common any more.

We rely on those that get paid to do the job to know what they're doing. As JP has alluded to and I agree, these days paramedics and EMTs are taught how to pass a test. While there is lots of learning that happens, especially in the paramedic programs, it's basic purpose is to get you to pass the test, not how to be a paramedic. You learn to "be" a paramedic after years of experience and by being mentored by stronger more experienced paramedics.

In today's EMS, you have folks that get out of school, get a job on a private transport EMS, get no or very little emergency experience, and clearly flounder when they are faced with a real emergency. It's very unfortunate.

The good news is that likely if something happens to you and you have to call 911, you're going to get very good care by trained professionals Unfortunately though, the contracted EMS I see at most race tracks, especially at local tracks, seem to be severely lacking with their personnel and the treatment I've observed.

I've seen very good care by the folks at Cresson and TWS (Texas World Speedway)- but both of them have off-duty Fire/ EMS personnel working that contract too. Oak Hill's contracted EMS is a private transport service, but they provide 911 service to the area, so they're an exception. Eagle's Canyon folks seem like they're OK, and they did a good job too the single time I observed them working with a rider.

I don't want anyone to get me wrong here, I'm not saying that you shouldn't be seen by an MD, all I'm saying is that if you're able to make decisions and are "with it", be an active participant in your transport decision, not just an onlooker.

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i would be curious to see the list of injuries that had a life flight requested, and the transport time to a level 3 trauma center and transport time to level 1 trauma center.
This is irrelevant.

To compare treatment/ transport in hindsight knowing the outcome of the patient is something shifty lawyers and insurance companies practice.

What needs to happen in regard to your statement is a quality ongoing review and quality assurance program within the provider. So many providers have gotten away from chart audits and peer review and that is a travesty! Especially with volunteer and private transport EMS, most of them don't do it at all or never have.
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Old 03-08-2009, 11:22 PM   #15
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Brad,

When I had my crash last year at GSS and was life flighted, the helicopter ride was totally unnecessary. BUT with that being said I had a couple of "Things" go wrong. When I highsided I was knocked out for around 5 mins. But the EMT's didnt even know what they were doing. Ask Tim, Brena or anyone else that was there helping me off the track. It took them soo long just getting me on a back board. Then there was the issue of getting me off the track. It took them quite a bit of time just to find the Back Board. If I would of had any brain damage I wouldve been done for because it took them 2-3 hours just to get me in the helicopter! Then when I was being taken out of the EMS vehicle the wheels didnt come out on the gurney and was dropped on my head. Like I said the EMT's didnt know what they were doing.

The big thing was that the EMT's didnt know what the f*ck they were doing.
In the end I was discharged from the hospital with a sprained back.
Aprox = $11,000 Life flight
Aprox = $4,500 Medical Treatment

Insurance covered a good majority of it. I paid about $1,000 for the deductible. Of course, when your riding on the edge of your limits at the track eventually you find the edge. But thats the risk you take when you go to the track.

GSS also had changed the EMS service since our last visit there so we dont need to worry about incompetent EMT's anymore


Quote:
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Everyone please don't jump to conclusions on what I am saying here, but it sounds like life flight is used on trackdays when it isn't always called for. I understand the worries over a head injury or a fracture in a place where bleeding is a major concern.

I just have this feeling that maybe the medics paid to be at the track should do more than call in a $15k helicopter ride.

I do hope that if, and when, I am in need that they make the best judgement they can and to the safest possibility. Be it life flight, or a bandaid.


I would like to hear from Dustin, Matt, and others about their opinions on this as they have been in the riders position themselves.


Am I looking at this wrong, or is the trackside medic crew doing little more than addressing a situation and calling someone else in to take care of it?
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Old 03-08-2009, 11:24 PM   #16
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Quote:
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This is irrelevant.

To compare treatment/ transport in hindsight knowing the outcome of the patient is something shifty lawyers and insurance companies practice.

What needs to happen in regard to your statement is a quality ongoing review and quality assurance program within the provider. So many providers have gotten away from chart audits and peer review and that is a travesty! Especially with volunteer and private transport EMS, most of them don't do it at all or never have.
actually it is quite relevant. that kind of information is needed for the quality improvement process. Being able to determine if protocol needs to change or if protocol is even being followed is important for future training and education of emergency care providers. It is not a matter of punishing individuals, it is a matter of improving the system. Protocol requires that you err on the side of caution, on the side of the patient.

EMS protocols also identify certain mechanisms of injury as significant, and require immediate and rapid transport. Motorcycle crashes in excess of 20mph or with separation of the rider from the bike are considered significant. There are other indicators of a significant injury as well as what is considered a critical injury. For example a broken femur is considered a critical injury, and the injured party can lose as much as 1.5 liters of blood due to a femur fracture.

So in other words the injury assessment done in the field as compared to what is diagnosed in the hospital can make a huge difference. If a guy in the field assesses repeatedly is WAY off then he should not be hired if you ask me. The other thing is what does protocol require, it may be that protocol is not clear, nor specific, or leaves too much in the hands of minimally trained people.

Regardless it sounds to me that protocol needs to be revisited as well as the skills of the EMT's being hired.
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Old 03-09-2009, 01:30 AM   #17
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actually it is quite relevant. that kind of information is needed for the quality improvement process. Being able to determine if protocol needs to change or if protocol is even being followed is important for future training and education of emergency care providers. It is not a matter of punishing individuals, it is a matter of improving the system. Protocol requires that you err on the side of caution, on the side of the patient.

EMS protocols also identify certain mechanisms of injury as significant, and require immediate and rapid transport. Motorcycle crashes in excess of 20mph or with separation of the rider from the bike are considered significant. There are other indicators of a significant injury as well as what is considered a critical injury. For example a broken femur is considered a critical injury, and the injured party can lose as much as 1.5 liters of blood due to a femur fracture.

So in other words the injury assessment done in the field as compared to what is diagnosed in the hospital can make a huge difference. If a guy in the field assesses repeatedly is WAY off then he should not be hired if you ask me. The other thing is what does protocol require, it may be that protocol is not clear, nor specific, or leaves too much in the hands of minimally trained people.

Regardless it sounds to me that protocol needs to be revisited as well as the skills of the EMT's being hired.
you are correct with the mechanism of injury. motorcycle accidents, bad car accidents, ie with ejection, falls over 10 ft are considered all high mechanisms of injury. theyre are alot of "jake leg" private ambulance companies that hire joe bob the dumb ace. but alot of good ems workers and firefighters do that as a side job on their days off. it all comes down to that persons call. if it came down to it, and they have any doubt their could be something life threating going on, esp in a rural area, chances are youre gonna get flown. yeah medical prices are astronomical, but at the end of the day, id rather you be out 1000 bones, then you be out of time.
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Old 03-09-2009, 04:52 AM   #18
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Quote:
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Sitting here in the comfort of my recliner and with perfect hindsight, I would have driven myself to the emergency room. But at the time, even though I thought I was was thinking clearly, and I was, I could not be sure there was not a head injury or some internal damage. Getting directions and driving to a hospital I'd never been to or driving 25 miles to one in Houston would not have been smart. Getting checked out by a doctor is the most sane choice.

As has been written in a different context, leave the ego and testosterone at home. As Tom wrote, many people who thought they were fine have gone home and died soon after. My complaint is not that the ambulance took me off the track or that the EMTs' put me on a back board but that they wanted to call Life Flight for non medical reasons and perhaps political reasons. They didn't like the Angleton hospital and they wanted to see the helicopter. Those of us who get injured are depending on the medical personnel to make reasoned decisions.
Please understand they have a good reason to not take you to that hospital there is a reason to not go thare
In Waco I was a emt basic but I had lots of otj training if you had a heart attack you went to providence but you bumped your head you were going to hillcrest simple as that angelton might suck for inj. of that nature
Imo they shouldn't allow 18 yearold kids be an emt they don't have everything sorted out upstairs to make a clear judgment in those situations that applys for the wannabes that entered that line of vol work because it's the closest they could get to being a cop I know it sounds crazy but every vol dept has one
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Old 03-09-2009, 06:59 AM   #19
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I am going to advise all of you to not make statements based upon incomplete information, this could lead to alot of trouble. The PT. always has the right to refuse treatment, parts of a particular treatment and transport of any kind. The different levels of certification, have under the "Standards of Care' different levels of treatment and each of the persons are responsible to maintain that "standard of Care" to the level they have been trained to. what is a load and go to a basic EMT is not necessarily the same for an intermediate or Paramedic. let us NOT make the assumption that it is all the same.

I do believe that all tracks,venues or rereational facilities that have either large groups or risky/dangerous activities should have "on staff" a Paramedic at least with a Medical Director(doctor) on call during operation. It is very unfortunate that they don't and cite the reason of "cost" most of the time. The other thing they do too much of is have a nurse on staff, and nurses have absolultly NO prehospital standing under either the medical paractice act or the EMS act, so the care rendered is substandard, but it continues to the present time.

As far as protocol is concerned, protocols/standing orders are how EMT's and Paramedics are controlled without direct MD supervision(no a nurse cannot be a medical supervisor to any EMT) These "protocols/standing orders" control and specify what an EMT is to do in a situation, no they are not all inclusive and many times the judgement of the EMT/Paramedic is used, however many services especially those using Houston Med Con have given facilities that a given injury or mechanism of injury is to be transported to or method of transport to be used. These portocols are to be followed to the letter and if deviated from there MUST be documented valid reasons as to why the deviation occured.

Like Tom said it is my opinion that the people who are being certified currently are being taught how to pass the NR test and the NR is considered the end all in certification, the Private transfer services do NOT invest in the people who staff the ambulance, the main reason this is, is that when a person has more experience and knowldge they want more money. The private transfer services opinion is generally " why should I pay you more when there are a hundred just like you waiting to take your place?" its a sad state of affairs when the person holding your life in his/her hands is paid between 7 and 16 an hour, with no benefits, and the pay doesn't apply to just private transfer services it also applies to many of the small regional 911 services.
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Old 03-09-2009, 07:11 AM   #20
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Quote:
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That's a great theory. It works only in theory though; here's why.

There are cases (lots of them) where insurance companies are suing providers for over-treatment. Insurance companies are also refusing to pay for over-treatment and sending the charges on to the patient, then the patient sues the provider for the fees.

Air medical is not a cheap thing, for a 20 minute flight, they charge around $2500 just for the flight, and that includes no treatment. Charges can easily top $10k as a starter.

I'm not sure what this situation was that is referenced here, but if it's what I'm thinking, I have a hard time believing that the injuries are what is claimed... whatever.
not quite right Tom if you are sued for over treatment it is harder to win and if won you pay a small amount. If you are sued because of bad outcome it is easier to win even if everything was done correctly and the amount of pay out is massive.
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