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Old 23rd Dec 2004, 22:40
  #21 (permalink)  
 
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SA
You beat me to it, I remain a little bemused and find it hard to explain that if someone has a fall in the bush and an ambulance can get access, no need for a doctor. As soon as access becomes difficult (ie long dirt track, and helo required to speed up recovery/on scene assistance) then paramedic becomes useless and a doctor is the magician because he is in the helicopter.

Don't these paramedics eat these types of jobs every day of the year and you never see a doctor on the roadside. I certainly respect the doctor's knowledge and skills and it is great having him/her waiting in the resus room to work their team on arrival but "why oh why" do we make out that as soon as it becomes a helo job the job is beyond the capabilities of a para?
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Old 23rd Dec 2004, 23:56
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Many years ago when I started out in the helicopter business, all the pilots received some first aid training from the St Johns ambos. It was pointed out to us both by the ambos and doctors that the best person at an accident scene was an ambo because that was all he was trained to do whereas doctors were more medicine and hospital orientated.
No doubt if there were sufficient docs of Robbos experience that would be great but there isn't.
So for me a broken leg, I would like an ambo. For a heart transplant, I would like a doc.
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Old 24th Dec 2004, 13:33
  #23 (permalink)  
 
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That age old arguement (not the QR one, the para V doc)

I tend to see it in a different light (as usual). It is all about resources, resources, and resources.

Lets take one-are's excellent point: the bushwalker. On the face of he is 100% right, why send the doc when a para will do? There is no refuting this arguement, but it makes too specific a "what if". The helicopter is a far more expensive asset to buy and maintain than a road ambulance, yet it fulfils that role. So why then would we waste all that resource on another ambulance? We dont. The EMS helicopter has two primary attributes to justify its higher resource requirement: access ability and speed.

The access ability is exactly where one-are is coming from, and that example is a good one, but it is only half the arguement, and one-are argues it well.

Speed of the helicopter is used on many levels. It is widely acknowledged that time can be of critical importance in a limited number of cases, but these cases cannot always be determined until specialist evaluation. If we wished to achieve speed of specialist care, we need to get a specialist doctor or specialist access rescue personnel to the situation ASAP.

To take this to extremes, if we had unlimited resources (and training facilities) we could have trippled the number of intensive care wards, have each of the tenfold increase in road ambulances manned with a mobile trauma capability and docs with RobboRiders experience, entrapment rescue specialists at every intersection and blackspot, etc, etc, etc. But obviously, we have limited resources, so how can we increase response speed to the best possible configuration, with the least amount of resource expenditure? We concentrate groups of the specialists in a population/distance matrix and supply them with the fastest response means: a helicopter. AN EMS helicopter.

This is the same way we do with the limited resource of the paramedic on road ambulances. The ideal would be to train all ambulance officers to paramedic standard, and then Special Casualty Access Team standard, but actual resources have forced a limited amount of these people and thus a strategic placement of them around the state.

Now back to the helicopter. It is merely a means of getting a higher trained medical resource to a scene faster AND it can fulfil it's other role of getting to areas ground ambulances cannot. Because we have been forced by resource issues to concentrate the specialists on these helicopters, there are occaisions when it is overkill to send them, such as the example that one-are paints. That is the price of limited resource.

The other NSW helicopters that are mentioned as non doctor operations are non doctor as a result of resource issues, not as a result of preferences. But in this resource limited world, I would suggest that NSW will have a hard time puting doctors in all the helicopters. In the mean time, part-time helicopter paramedics will continue to serve the people of NSW in the highly professional and selfless way that they have done for 30 years without the resources that they could so easily use.
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Old 25th Dec 2004, 08:59
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Helmet fire has it right. In a resource unlimited world we would have people in every job who have only the highest level of training needed. Including helicopter pilots, but back to the real world!

There is a fair bit of selective reading going on so I need to reiterate I am not talking about the stuff where my blue-rinsed granny with a hanky dipped in iodine could get the job done. If the patient needs someone with first aid training then no one could justify the cost or overkill of sending a doctor (except maybe as an exercise as keeping up skills in a hostile environment).

But a problem with this philosophy is that often the information that gets back to those who decide who should go is often wrong – either worse or better than reality. I did many trips where the info we got was that all hell had broken loose but when we got there it was a job for granny. And the opposite as well – “stable patient” who was actually ready to die and the other scenario which was very common – simple job hardly worth the doc going – diversion in flight to a real job – thank God we have all the gear and doc on board.

Smilin’:

“After all isn’t an Aeromedical Helicopter just a flying Ambulance?

Not no more. That’s the whole concept of the updated version of the “Golden Hour”. The aim is to take the hospital to the patient.


“I read with interest the latest NSW Rescue Helicopter review which stated a Doctor was “world standard” crewing. From my knowledge of Aeromedicine around the world, it seems a Paramedic and Flight Nurse seems to be the norm.
S.A.”

I have to disagree with their statement. It may be the ideal but the actual situation varies from continent to continent, country to country and area to area within the country. Its dictated by mostly economics, as Helmet-fire said.

And also by the type of patient who makes up the majority of the caseload. A service in an area with lots of injuries from say, ski-ing – essentially fit young healthy people who are acutely injured – may well be served adequately with para/nurse teams. Change that to a service with a high load of ICU transfers and regional hospital transfers, older population etc and once a critical threshold of these cases is reached you can’t justify not having doctors who can manage these types of patients.

And also on medical staff demographics. If you have a country with enough doctors, with specialist training curriculae that require/encourage external hospital experience as part of the course you are going to have the doctors available to do it. Go somewhere where that doesn’t exist you will have Buckleys chance of finding a doctor to man the service.

Which is why it’s so hard to compare services and say one is better than the other. Often you are comparing apples and oranges.

Nigel:
“It was pointed out to us both by the ambos and doctors that the best person at an accident scene was an ambo because that was all he was trained to do whereas doctors were more medicine and hospital orientated.”

Kind of unreal world concept that doctors can only work in hospitals and somehow loose their marbles when they walk outside the building. That’s a mindset not a reality. Now I wouldn’t expect an intern to be able to go out unsupported cos they can are still finding their feet in the hospital let alone outside it. But we are talking about specialist level docs.

“So for me a broken leg, I would like an ambo. For a heart transplant, I would like a doc.”

So long as that’s all that’s wrong. Make it a slightly older person – broken leg causes on average 1 ˝ litres of blood into the leg. Some narrowed coronaries due to age and diet – less blood to heart – heart attack. Heart function drops off and lungs fill with fluid – patient now in heart, lung failure and by the time he’s sorted out in ICU also kidney failure from the cascade of low blood flow through kidneys. All from a broken leg. (real case, by the way)

So long as you get the diagnosis right in the first place and it’s really a simple as you think it is.

But in reality it’s back to resources (with some turf wars thrown in for fun).

Merry Xmas everyone!
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Old 25th Dec 2004, 09:27
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“After all isn’t an Aeromedical Helicopter just a flying Ambulance?

Not no more. That’s the whole concept of the updated version of the “Golden Hour”. The aim is to take the hospital to the patient.

Very true.

I worked in Ontario Canada for the better part of 3 years in the Air Ambulance system there. I would not hesitate to say that the PARAMEDICS working there are the finest in the world. They operate to a continuing high standard of critical care medicine and are considered to be the "experience" and education level of a 2nd year resident.

Quite honestly, I would prefer a Critical Care Paramedic over a resident anyday.....no offence intended Robborider. I am sure any number of experienced air ambulance pilots would testify to the same.

They intubate, chest tube, inject and run a bag of drugs that is as good as any ER in North America. I have seen some astounding feats of medicine committed in the back of an S76.

What is needed in the Aussie scene is just a little more perspective of what the rest (some) of the world is doing. Sure you can send a doc but an Advanced or Critical Care medic will do almost as well. Throw in a sat phone and you have a direct link to an ER and instructions for care. The paramedics are tools that can be used by an experienced physician and one doc can run a lot of aircraft at one time.

From a pilots point of view: The most frustrating part is the egos from the Docs to the Nurses to the Paramedics to the dispatch to the...
It just goes on.
As pilots we tend to learn and improve off each other. In medical circles everyone believes their method and everyone else is doing it wrong. Nurses are threatened by Paramedics taking the Pediatric calls (thus reducing their teams viability) and the Doc's think the Paramedics know nothing etc...etc...

Personally, I am glad to have seen it all. I loved doing it but threads like this one just remind me that the politics of the job completely overwhelm the moral satisfaction of thinking you actually made a difference today.
Its all about the money....

www.basehospital.com

Check out the promo video and the patient simulator shown on the intro page. Good ****....
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Old 26th Dec 2004, 21:53
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Thumbs up Para any day!

As someone that is directly involved in all aspects of EMS operations for many years, as aircrew; GIVE ME a Para any day over a Doc at an accident scene! Para’s are efficient, safe and competent. This allows an expeditious transfer to hospital for the casualty. Doctors, on the other hand, just get in the way of their own self importance. They want to be in control of the whole operation rather than just concentrating on their ‘JOB’ of saving a life.

As someone speaking from experience I would much rather a Para working on me at an accident scene than a Doctor. In fact, if I can be picky, I would have either a Victorian Para or a South African Para working on me any day.

Have a nice day!
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Old 26th Dec 2004, 22:36
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Yes Helmet, QR has been going through some very interesting times. The investigation in Townsville was something to do with nepotism or better termed ‘jobs for the boys’. Apparently, there were people that were told they had jobs even before those jobs are advertised, friends of staff etc. Not sure of the outcome of the inquiry but like most government investigations it would have been swept under the table. It is scary because these people are handed a lot of responsibility with what seems little experience. This all follows the ‘ousting’ of the former senior-crewman in Townsville and numerous other pilots that don’t play the game. Not sure of all the details, maybe someone can fill us all in on the outcome of this investigation. ‘Scattercat’ maybe you?

This problem together with the huge financial cost of QR is understandably why Townsville has been selected as the first base for the commercial trial. Lets all see what happens. I know the government wants to retain QR because of the great PR aspect of the organisation, so it will be interesting to see how much of the transition gets released. I believe the government is in negotiations with potential contenders. I am not sure if Care Flight is one of them.

Richard
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Old 27th Dec 2004, 19:00
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The Victorian EMS model has been working brilliantly for nearly 30 years. Its fast, its slick and it works.
The horror stories I hear about waiting for this 'magical doctor' to turn up to the helicopter while the poor bastard bleeds out on the side of the road are frightening. Zoomtrap, I couldn’t agree with you more.
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Old 28th Dec 2004, 01:21
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D. Insider
Have you not heard the saying "a little bit of knowlege is dangerous"??
You obviously know a few bit's & pieces about this organisation from which you have based your comments & predictions of the future. I notice in your posts a lot of ... "Apparently's / Not sure's and I believe's". Now, I know this is a rumour network, however you are getting very close to making some serious allegations of impropriety on the part of a well respected government rescue service. As I mentioned earlier ... time will tell if your predictions of the future of QR Townsville comes true. (Though I don't believe they will) I know that you are incorrect in some of what you say so I doubt the accuracy of the remainder.
As for "Nepotism" ... the recent recruits in this organisation are highly experienced professionals who are well suited to the positions they have. (are you a disgruntled unsuccessfull contender perhaps??)
This all follows the ‘ousting’ of the former senior-crewman in Townsville and numerous other pilots that don’t play the game.
Exactly which "game" was it that these people wouldn't play??
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Old 28th Dec 2004, 07:44
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Danger QR

Dear D-insider,

I'm intersted in the accusation that some QR Pilots have been ousted for not playing the company game!!

Just what is the game? We know that Townsville has had problems with pilot retention and have lost good crew members but surely not all of them have been asked to move on, some may have jumped !!!

Has nepotism been proved (next door neighbours son doesnt count)..? And surely Careflight wouldnt have the spare capacity to run Townsville.

Seasons Greetings

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Old 28th Dec 2004, 07:46
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Haven't seen a 'Request for Tender'. Do they have those in Queensland, surely they must. After all they wouldn't want to act improperly.

Methinks red budgie just got hit by a bus
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Old 31st Dec 2004, 10:10
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Insider, sounds like you have hit a sore point with some viewers, maybe you are getting close or closer to the mark, which concerns me as I have heard similar info from the guys in Brisbane.
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Old 1st Jan 2005, 10:25
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NO!

Perhaps Scattercat needs to organise to have the site changed from the 'Professional Pilots Rumour Network' to the 'Professional Pilots Serious Allegations of Impropriety Network’ then there wouldn't be a need to worry about these fantastic rumours.

Richard
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Old 1st Jan 2005, 11:07
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I really feel Sorry for you D Insider. I have watched this thread with interest. You really seem to have a personal beef and want to use this thread as some sort of Payback. Be a man and contact the organisation if you have a problem with them. If you have been knocked back for a job we can all see why.

My information close to the source is there has been no investigation into Townsville, No intention to Tender out the bases. In fact they are about to enter into new purchases for the replacement 412 fleet. Dont think that would happen if they were going to wind the service down. Also, Dont cloud the Doctor Issues as QR issues. Only makes you look like you dont know what you are talking about.

How about you make a deal. When all your predictions dont come true, Apologise to Scattercat, and change your dame to D outsider.

By they way Contact QR or the Goverment if you have a problem. Make you allegations formal and public. I know they would be delighted to have the oportunity to formally answer any allegation you wish to put to them. You say they will only sweep things under the carpet. No can do in this governments day and age. Go higher to CJC, Ombudsman. I am sure they will welcome the challange. They are too professional to respond to someone hiding behind a code name. Otherwise.........
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Old 1st Jan 2005, 20:11
  #35 (permalink)  
 
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D. Insider

You started this thread you silly twit!!

This is the second topic you started regarding the two operators in that region (CareFlight and QLD Rescue).

I agree with bladeflap. The only new thing QR is looking at doing is replacing the aircraft - no more. You must have a mighty big axe to grind with someone.

Get your facts straight and pull your head in.
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Old 5th Jan 2005, 04:13
  #36 (permalink)  
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Good to see some robust debate on the subject has developed.

‘Bladeflap’ they would have to pay their drivers a bit more before I look at applying for a job with them. Do they have a fixed-wing yet? Has anyone seen the wet lease option for the new aircraft proposal?

Richard
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Old 5th Jan 2005, 10:36
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After looking at the real cost to the Victorian Government for the Vic Police Aircraft (ie. Standing charge and hourly charge) I don't think the Qld Govt would ever entertain the idea of a wet lease. As for CHC running a cheaper operation. I think not. Get them to supply the same machine with EFIS, 4 axis, same number of crews working a reasonable number of hours, (not that 56hr/week 3/3/3 crap) then add the required profit margin to the parent company, then add in a 0 accident record and I don't think CHC could match the Qld Govt. Whilst comparing accident rates, perhaps the respective State Governments should take over the community providers. This might stop some of the bitching.
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Old 5th Jan 2005, 21:36
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Wallaby,
Why do you think government's go to private (commercial) type companies to run these services? As you mention if you look at the 'real' cost to the Vic Government to run Polair, I think you would see that a private (meaning non-government) operation be it CHC, Bristow, Jayrow will be a cheaper service to run than if they did it themselves (Capital costs of NEW airframes/spares parts etc etc (see standing charge/flying hour charge).

How may 4 axis machines are QR running?????? (I mean actually using the auto-hover function, possibly Spida may use it occasionally) CHC run 5 at the moment. With regard to 'crews working a reasonable number of hours' - this is where the FRMS dictates what a reasonable number of hours a pilot should perform.

PS: And the crew/s would get paid more than the QR guys but that's another story).

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Old 6th Jan 2005, 09:18
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Wineboy, if wet leasing is such a good deal, why do companies like CHC and Esso still buy their own machines. Esso have the d.o.c's for their 76's down very low. They own the airframes and have PBtH on their engines and xmsn only I believe. As far as the auto pilot goes, a machine with 4 axis even without auto hover is a quantum leap over and far safer than a 3 axis machine. There are two 4 axis machines in QR and I believe the auto hover machine is now in Brisbane not Cairns.
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