Some reasoned justifications in favor of jet fuel and flight suits

In the EMS world, it’s become almost fashionable to question the need for helicopter-based EMS (HEMS).   I personally believe that HEMS has been overutilized on occasion, probably even by me.  (I have a lovely snark-gram from the QA gremlin about that, in fact.)

Having said all of this, I think there are some reasoned, nuanced justifications for HEMS.  Allow me to share a bit, if you will.

1) The “Golden Hour” may not be evidence-based medicine, but there’s definitely a few cases where interventions are time-sensitive.  We can all agree that a multi-system trauma patient or a head injury is best treated in the operating suite, preferably sooner rather than later.  Likewise, there’s a specific window of time for thrombolytic therapy for stroke.  And we definitely know that reperfusion times matter for myocardial infarction.   HEMS adds a speed factor in these cases.

2) Most areas don’t have ground-based critical care transport program.  As such HEMS becomes our default CCT option.  Multiple drips and vent settings on the acutely ill patient, whether encountered on a 911 call or in a transfer to a higher level of care, require critical care transport.  In the vast majority of the country, flight medicine is the default critical care provider. If we want to cut down on HEMS utilization, we’re going to have to provide a ground-based CCT alternative. (And a 40 hour class intended to comply with Medicare regulations governing billing for “specialty care transport” just isn’t going to suffice.)

3) Especially in lower volume EMS systems, HEMS providers are a welcome supplement on critical and special needs populations.  As much as I try to enhance my knowledge and skills, I don’t always get to see enough truly “sick” patients or enough pediatric patients to have the comfort level that I’d like to have.  For providers in less populated areas, the ability to refer the sickest and/or rarest populations of patients to providers with (potentially) more experience and more comfort is not necessarily a bad thing.

4) In some EMS systems, HEMS does bring additional medical interventions and resources to bear.  Blood products and ventilators do provide a benefit in some cases.  In many cases, HEMS operations may have an expanded drug formulary as well.  Some HEMS providers are also using ultrasound and video-assisted intubation. Granted, the cases where a drug or a particular intervention may be truly life-saving and needed “RIGHT NOW” are few and far between, but knowing that the option is there is helpful, again for the sickest of the sick.

HEMS has a poor safety record in many instances. Some HEMS operators engage in questionable marketing practices aimed at both ground providers and the general public.  But until ground EMS steps up its clinical game and offers true critical care medicine, both in terms of provider knowledge and expertise as well as protocols, HEMS will be a needed, if occasionally overutilized, resource in the majority of the USA that’s more than thirty minutes away from truly comprehensive care.

Ice Buckets

As a conservative/libertarian type, I’m in favor of individual charity rather than the enforced charity that the IRS collects every April 15.   As such, any giving to charity should be encouraged and celebrated, both for individual self-worth and the good that charitable giving does for society as a whole.

Having said that, though, the Ice Bucket challenge movement is beginning to annoy me.  It’s the “selfie” of charitable giving.  It’s the self-absorbed “look at me” mentality that seems to infest social media.

The twelfth century Jewish philosopher Maimonides proposed the following ladder of giving:

  1. The lowest: Giving begrudgingly and making the recipient feel disgraced or embarrassed.

  2. Giving cheerfully but giving too little.

  3. Giving cheerfully and adequately but only after being asked.

  4. Giving before being asked.

  5. Giving when you do not know who is the individual benefiting, but the recipient knows your identity.

  6. Giving when you know who is the individual benefiting, but the recipient does not know your identity.

  7. Giving when neither the donor nor the recipient is aware of the other’s identity.

  8. The Highest: Giving money, a loan, your time or whatever else it takes to enable an individual to be self-reliant.

I’ll let you judge where the cold water or ice bucket challenges lie on this ladder, especially “calling out” others for the so-called challenge.

I’m no saint and definitely far from perfect, but I have made a different decision for me.  For me, I’ve chosen to give the gift of my time.  I give my time as a paramedic, volunteering in two different EMS systems.  I give my time (usually freely) as an EMS educator, educating our community about the legal issues involved in prehospital care.  And I’ve lost count as to the numbers of times I’ve spent on the phone or computer providing some quick, informal legal advice to medics, firefighters, or cops.   These are the challenges I’ve chosen to answer on my own, with no towel or recorded message required.

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