Risk vs. Reward and Patient Advocacy

An OLD shot of Savannah's LifeStar landing for a Hilton Head Island F/R medevac.

The SC-TF1 Director copied an article to our command staff that I found interesting.  It ran in Popular Mechanics titled Unacceptable Risk (I couldn’t find a direct URL for it, so here’s the pdf: HelicopterCrash).

Our organization allows paramedics on scene to request a medical helicopter evacuation with a minimum amount of oversight by the medical control physician.  Being a paramedic myself, I know when to call for a flight and when not to.  I am not about to call for a chopper to take a patient to a hospital for a broken foot, and likewise, I am intelligent enough to be able to assess a patient and opt to fly them to a hospital that has the resources to help my critically injured victim.  I am appalled at some of the case histories where someone was flown out for a routine (very routine) injury and consequently, I know of agencies who simply won’t call for a flight, regardless of the need for it.

How bad of a medic must you be that you can’t tell the difference between a potentially life-threatening injury and one that can be transported by ground to a hospital?  If I’ve got an altered patient with a potential head injury, I know they need to go to a trauma center.  So what if I have to go on an out-of-jurisdiction transport to the trauma center- it’s what we do.

Regardless of whether or not the aeromedical evacuation of a patient is risky and may or may not have tangible benefit, the decision must come to this: What do I need to do for the best interest of the patient? I don’t care if you don’t like the way they look, or they stink, or you are tired.  When you became a medical response professional, you probably took an oath that involved a statement like “Above All, Do No Harm”.  Our jobs involve making sure our patients not only get care, but that it is the right care, it is not care that is provided at a huge cost because we were too lazy to do our jobs, and that the patient’s rights are maintained in their treatment and transport to a medical facility (or not).

Just as I wouldn’t make you take a treatment that could possibly kill you in order to cover my ass, ordering a helovac for a finger amputation isn’t in my first line of thought.  And I know I curse and fuss when I DO call for a chopper and a spot of rain on the pilot’s windshield causes them to scrub the mission, but you know what? I’m a big boy- I’d MUCH rather you err on the side of keeping your crew and my patient safe and I’ll deal with the fallout otherwise.  But to just say, “All patients go by air” or much worse, “No patients go by air” is ridiculous.

Maybe like everything else, we need to stop applying a broad brush to a situation and do our jobs, by appropriately assessing our patient, determining their logical needs based on mechanism of injury, observable findings, and our experience, and make a good call as to what to do with them.  If we ca’t do this much, it’s no wonder we continue to have to convince people we aren’t just “ambulance drivers” but real, live, medical professionals.


  • Dear Mick,
    I too hate it when discretion is lost. It’s so easy to correct a mis-handled situation–you talk it out later and it’s training.

    I notice, in an entirely different arena, our Board (of which I am a member) is doing something similar. We don’t trust our manager and have taken to asking for additional reports so we can get a handle on things. We have now asked the impossible and become untrustworthy ourselves.

    Ann T.

  • truck6alpha says:

    Ann T.,

    Unfortunately, it seems like the higher up the food chain, the harder it is to govern the actions of the subordinates directly below you. As a result of their position, you have to rely on their ability to maintain focus and demonstrate integrity, but you have to permit them a wide berth so they can use their creativity and judgement to achieve stretch goals, and foster growth. It’s a balance that many managers/CEOs have to tread; some do it well, some do it poorly.

    Unfortunately, we usually end up reading about the ones who do it poorly in the news.

    Good luck and thanks as always for reading and commenting. Your insight is always valuable to me.


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