Have You Ever Regretted Calling Aero-medical?

Have you ever regretted calling aero-medical? I have. The death this week of yet another flight crew member leads me to continue to re-evaluate my use of aero medical. I find myself moving toward the end of the spectrum that calling the helicopter based entirely on mechanism of injury doesn't cut it any more (I'm not talking about getting them in the air--just in case--AS YOU RESPOND to a scene, I'm talking about having them CONTINUE in when you've arrived and done your preliminary assessment).

I responded as an intercept paramedic to an auto accident in which the fire department I was intercepting with had called Flight-for-Life prior to my arrival based upon their assessment of the amount of damage to the vehicle. On my arrival, I found a moderate amount of damage to a vehicle, star crazing of the windshield, and a patient exhibiting no signs or symptoms of Level I trauma. We were one minute from the nearest ED (Level III) by ground, and the helicopter was headed to that hospital's landing pad.

I was inclined to cancel the helicopter, but since it was landing at a secure, hospital landing pad, and it was only a few minutes away, I decided to let it continue in as a courtesy to the ED in case they decided to use it to move the patient to the Level I trauma center (40 minutes away by ground). My thinking was, "What if I cancel this helicopter that I'm pretty sure I don't need, and the hospital does their CT and calls them right back? Someone's going to tear me a new asshole for cancelling them."

I called in my patient report to the ED, stating my field impression of a relatively uninjured patient with good vitals and neurological status and shared my initial impression of a patient that doesn't require air evacuation. I told them I was allowing the helicopter to continue in to their pad just in case they wanted to use it. I used my legal-magic EMTALA catchphrase "I am requesting your assessment of this patient and stabilization if necessary..." at the end of the radio report.

When I arrived at the hospital and we entered their ambulance bay, an RN came into the bay to speak with me. This is in direct violation of that hospital's policy which states that staff will not approach an ambulance that has summoned Flight-for-Life because they don't want patient contact if the patient is being loaded directly into the helicopter. To have contact requires assessment, and the patient would have to be brought in.

The RN said to me, "He's going directly into the helicopter, don't bring him in." I responded, "I requested your assessment over the radio." The RN shrugged and said, "Dr. XXXX says he's not to come in."

I know this doctor, and I think he's a complete raging unethical piece-of-shit asshole, so I'm happy to keep everything legal and formal. I stated to the RN, "I understand this hospital is refusing to provide patient assessment even though I specifically requested it."

We sat in the ambulance bay a few more minutes while the helicopter landed, and another five minutes while the helicopter crew entered the ED and began looking for the patient they expected to be inside. Finally, they came back out and approached my ambulance and took my report and my patient. After which I documented everything that happened, hoping that some insurance bureaucrat would read the language.

I would never hold off on getting the helicopter in the air and on its' way, but I am much more inclined to base my decision on what I see. I am a very cautious paramedic, and I am constantly thinking about the injuries I cannot see or assess, but there has to be SOMETHING in addition to pure mechanism for me to think aero-medical is the right way to go.

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