More on Helicopters

From JEMS:

NTSB urges steps to prevent air ambulance crashes

The National Transportation Safety Board issued stringent safety recommendations for air ambulances Wednesday, after investigating 55 crashes that killed 54 people and seriously injured 19 others between 2002 and 2005.

Included in the NTSB’s inquiry, which focused on the crashes of 41 helicopters and 14-fixed wing aircraft, was the fatal flight of a Colorado air ambulance company in which a crew of three died in early 2005.

The number of crashes, fatalities and injuries “clued us in that there were safety issues” and led to the recommendations, said Lauren Peduzzi, spokeswoman for the NTSB.

The recommendations, made to the Federal Aviation Administration which is the rule-making agency, include:

* Impose the same safety rules for flights going to pick up patients as those with patients on aboard.

The NTSB said that 35 of the 55 accidents reviewed involved flights with no patients on board, including the Steamboat Springs-based Yampa Valley Air Ambulance crash near Rawlins, Wyo., on Jan. 11, 2005.

* Require that air ambulance operators have risk-evaluation procedures that assess weather, geography, aircraft safety and pilot fatigue before every flight.

The NTSB said the formal risk procedures might have prevented 13 of the 55 accidents, including the Yampa Valley Air Ambulance crash.

* Require flight-dispatch rules for operators that include updated weather information for pilots, aircraft tracking and arrival notification.

Those dispatch rules might have prevented 11 of the 55 accidents, including the Rawlins flight, which ran into heavy snows and crashed into a ridge 2 1/2 miles from the runway’s end.

* Require that helicopter air ambulances have Terrain Awareness and Warning Systems. The NTSB said that the warning systems could have prevented 17 of the 55 accidents.

The FAA already requires the warning systems on turbine-powered airplanes with six passengers.

The National Transportation Safety Board recommends that the Federal Aviation Administration require air ambulance operators to:

* Impose the same safety regulations for flights with patients and those without patients.

* Create and follow a flight-risk evaluation program.

* Implement dispatch operations that include up-to-date weather for pilots and flight tracking.

* Install Terrain Awareness and Warning Systems on all aircraft and train personnel to use the equipment.

More on Helicopter Crashes

From Ascribe.org:

BALTIMORE — Post-crash fires, darkness or bad weather greatly decrease the likelihood of surviving an emergency medical service (EMS) helicopter crash, according to a study by researchers from the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy and Johns Hopkins School of Medicine. Improving crashworthiness of helicopters and reducing trips during hazardous conditions can decrease EMS helicopter fatality rates. The study was recently published online by Annals of Emergency Medicine.

“Crashes of EMS helicopters have increased in recent years, raising concern for patients, as well as pilots, paramedics and flight nurses,” said Susan P. Baker, MPH, a professor in the Bloomberg School of Public Health’s Department of Health Policy and Management and Center for Injury Research and Policy. “Our study found that darkness more than triples the risk of fatalities when EMS helicopters crash and that bad weather increases the risk eight-fold. Helicopter EMS programs should recognize these risky conditions and transport patients by air only when the benefit clearly exceeds the risk of the flight.”

The study authors examined National Transportation Safety Board records of EMS helicopter crashes between January 1, 1983, and April 30, 2005. During the 22-year study period, 184 occupants died in 182 EMS helicopter crashes. A majority (77 percent) of crashes occurred when weather conditions required pilots to fly primarily by referencing their instruments rather than using outside visual cues. In darkness, 56 percent of crashes were fatal, as compared with 24 percent of crashes not in darkness. One in four EMS helicopters is likely to crash during 15 years of service. The death rate for EMS flight crew members is 20 times the rate of all U.S. workers.

Former Va. EMT pleads no contest in prank death of colleague

From JEMS:

LEBANON, Va. — A judge convicted a former rescue squad worker of involuntary manslaughter for zapping a co-worker with defibrillator paddles in what turned out to be a deadly prank.

Joshua Philip Martin, 25, faces up to 10 years in prison when he is sentenced in March. Circuit Court Judge Michael Lee Moore, who found him guilty after Martin entered a no contest plea, said Monday he likely will order prison time.

Martin had been on the job four days when he carried out the deadly prank on June 1.

Courtney Hilton Rhoton told Martin not to touch her with the paddles, but moments later, he placed the device on her chest and shoulder and activated it, prosecutors said.

The 23-year-old mother of two small children went into cardiac arrest. Her body first stiffened and then went limp. Rhoton, who had been an emergency medical technician for one year, never regained consciousness and died three days later.

FOUR Score instead of the GCS?

From BrightSurf:

Mayo Clinic neurologists have created the first new, reliable and easy-to-use clinical tool in 30 years for measuring coma depth, a proposed replacement for the Glasgow Coma Scale. The new scoring system, called the FOUR (Full Outline of UnResponsiveness) Score, will be described in the October issue of Annals of Neurology, to be published online Friday, Sept. 9.

When using the FOUR Score, evaluators assign a score of zero to four in each of four categories, including eye, motor, brain stem and respiratory function. A score of four represents normal functioning in each category, while a score of zero indicates nonfunctioning.

A coma scoring system is used by physicians to initially assess a comatose patient to determine the severity of the brain injury, to monitor the patient’s ongoing progress, and to determine the best treatment during a coma. Scores also help physicians determine whether a patient is likely to live, and if so, how disabled the patient might be upon recovery.

Eelco Wijdicks, M.D., Mayo Clinic neurologist specializing in treating patients in intensive care and inventor of the FOUR Score, says a new scoring system is imperative due to limitations of the system used most commonly, the Glasgow Coma Scale.

ED Telemedicine in Mississippi

Information about the “TelEmergency” program at the University of Mississippi Medical Center:

In response to a lack of emergency care and physicians in many rural areas of Mississippi, the University of Mississippi Medical Center has developed and directs the operation of a rural health telemedicine initiative called TelEmergency.

Providing qualified emergency care in rural hospitals with low patient volumes can be cost prohibitive. Additionally, it is difficult to recruit and retain physicians to these areas. Utilizing a nurse practitioner as the healthcare provider, the Emergency Department of the University of Mississippi Medical Center effectively provides emergency coverage in participating hospitals through the TelEmergency system.

The nurse practitioner works under the protocol of the University Emergency Department, as approved by the Mississippi Board of Nursing and the Mississippi State Board of Medical Licensure. The nurse practitioner is specially trained by UMC to function in this unique model of healthcare.

Rural hospitals have contracted with the University of Mississippi Medical Center to allow the Emergency Medicine specialist backup for the nurse practitioners who completed the program and were hired by the local facility. When these nurse practitioners staff the rural ED, they communicate with Emergency Medicine physicians at UMC via T-1 lines and a sophisticated telemedicine setup.

Air Medical Safety

From the NY Times, via Symtym:

Air ambulance crashes killed 54 people, most of them pilots, paramedics and nurses, in a three-year period ending in early 2005, according to a special study by the National Transportation Safety Board.

The report, which was approved by the board on Wednesday, concluded that pilots were not good at analyzing risks and that the rules are too lax for flights that are not carrying a patient or a donated organ.

Helicopters and planes used as ambulances fly under airline-type rules when carrying a patient or organs. But if they are on their way to a pickup, they fly under rules that apply to private planes, which do not limit how many hours a pilot can work and allow flights in worse weather. Three-quarters of the accidents occurred under those rules.

“It seems like a ridiculous paper loophole that needs to be closed,” said one member of the board, Debbie Hersman. “You’ve got one, two or three medical personnel on board, and they have organs in their bodies. They’re just as important cargo as an organ for transplant.”

Investigators also supported a formal program of “flight risk evaluation,” in which the pilot and possibly a second expert would dispassionately score each mission, based on weather conditions, time of day and other factors. Of the 55 accidents, 13 might not have occurred if such evaluations had been done, they said.

While the number of crashes is up, including nine more crashes killing eight people since the end of the study, the rate of accidents is uncertain because of difficulties in determining the number of flights. According to the Federal Aviation Administration, there are about 650 emergency medical service helicopters; an industry group estimates there are more than 750.

Cigarettes and Oxygen Don’t Mix

Posted on Medlaw.com:

A resident died at an Escondico, CA, nursing home after his oxygen tank burst into flames, according to the San Jose Mercury News. The 67-year-old man was reportedly sitting outside at Palomar Heights Care Center and smoking a cigarette while his oxygen was turned on.

SNF employees sprayed him with a fire extinguisher after the tank exploded, but the man later died of burns and inhalation at a nearby hospital.

California’s Department of Health Services is investigating, the Mercury News reported.