"The Maryland State Police Aviation unit helicopters have one solo medic, cross-trained as a state trooper apparently as a way to distract the medics from medical skills." I call B.S. on that statement.
If you're going to post something that can be perceived as slander, you need to have very strong evidence to back it up - evidence that will withstand being the defendant in a slander suit.
Does this put Dr. Bledsoe's hypothesis in a different light? I think it does. The environments are completely different. We don't judge EMS system performance by ED standards, and we shouldn't judge EMS aviation by cath lab standards.
However, a mistake in risk assessment isn't unethical or criminal, it's just a mistake.
To critics of our system, I ask: What if the injured patient was your child or your loved one? Which risk would you rather we take: send too many to the trauma center within the recommended time limit, or send too few? A letter from Dr. Scalea, Physician-in-Chief, R. Adams Cowley Shock Trauma Center By Thomas M. Scalea, MD, F.A.C. S. Physician-in-Chief R Adams Cowley Shock Trauma Center Link to Free PDF at Emergency Education Council of Region 5, Inc.
In defending the quality of our system against those who would seek to diminish it, I know I speak for all trauma physicians in Maryland. I have received many emails and calls from EMS providers throughout the state who share this same concern. Most important, I know I speak for the tens of thousands of patients, and their families, whose lives have been shattered by injury, and whose recovery would not have been possible without Maryland’s vaunted trauma response system.
Injured patients with one or more of the following criteria were included: systolic blood pressure (SBP) less than or equal to 90 mmHg, Glasgow Coma Scale (GCS) score less than or equal to 12, respiratory rate less than 10 or greater than 29 breaths/min, or advanced airway intervention (tracheal intubation, supraglottic airway, or cricothyrotomy). “Injury” was broadly deﬁned as any blunt, penetrating, or burn mechanism for which the EMS provider(s) believed trauma to be the primary clinical insult.
In the multivariable logistic regression model, total EMS time was not associated with mortality (odds ratio [OR] for every minute of total time 1.00; 95% conﬁdence interval [CI] 0.99 to 1.01) (Table3). When the sample was assessed with 10-minute increments for total EMS time, there was no evidence of increased mortality with increasing ﬁeld times (OR 0.90; 95% CI 0.80 to 1.02). Similar results were obtained when total times were grouped by quartile (OR 0.95; 95% CI 0.83 to 1.08). We were also unable to demonstrate independent associations between mortality and any other EMS interval for the overall sample (Table 4).
In multivariable logistic regression models, there was no demonstrable association between time and mortality for any subgroup.