Helicopters and Hospitals

Landing helicopters on top of hospitals is not a good idea.

Landing a medical helicopter on a hospital landing pad can be a dangerous proposition under the best of conditions. Having a landing pad on top of your trauma center is flashy and exciting. All the TV shows do it! As we see in this story from the AP, when something goes wrong the outcome can be disastrous.

According to CNN, AP, and the local media coverage, Butterworth/Spectrum hospital in Grand Rapids, Michigan, endured a crash of a medical helicopter on the rooftop landing pad resulting in thick smoke and fire. According to the media reports several patient care floors had to be evacuated and power to the building had to be shut off. Surrounding roads and ground traffic were closed due to the threat of falling debris. According to available information at the time of this posting, there were no fatalities as a result of the helicopter crash. (Photo credit CNN.com)

Hospital trauma centers around the Nation utilize hundreds of air medical helicopter flights each day...safely...to bring trauma victims from emergency scenes to the trauma centers. There is little doubt that the appropriate use of air medical helicopters and trauma centers save lives that might otherwise be lost. Hospitals that have a need for air medical services can and should have designated landing pads (I think helispot is the correct term for those of you playing the NIMS home-game).

However, landing a helicopter ON TOP of a hospital is not a good idea...it never has been. This practice is flashy and dramatic, but not without risk. The crash at the Spectrum Hospital in Grand Rapids is a reminder of what can happen. As a result of this crash -several patient floors had to be evacuated -power to the hospital was disrupted -debris, smoke, and burning aviation fuel caused contamination and secondary hazard concerns, and roads were closed stopping surface traffic in the area. Beyond those issues, the "ripple effect" on a city or region include a drain on emergency response, surge issues on other hospitals as the Spectrum ED was closed (they are also the only level-one trauma center). Let's not forget that many major cities have hospitals in the in close proximity to other buildings and in the heart of the city.

Use air medical helicopters....yes, fly patients from rural areas to urban trauma centers...certainly, land the helicopter on the roof...no way. Landing in safe proximity to the hospital in a designated location is safer and can be nearly as efficient.

Consider the potential outcomes in the Grand Rapids crash and do a realistic risk/benefit analysis. The outcomes could have been much worse...and can be avoided.

To Live or Die in Disaster

The Associated Press is reporting on a panel of physicians who have made recommendations regarding who would and wouldn't get health care during times of disaster or catastrophe. The list is developed with the idea that health resources will be scarce or not readily available in times of crisis and the need for a more consistent method of triaging those resources. On the surface the idea has merit. The context and list-like approach are troubling.

The report recommends that each hospital have a team assigned in times of crisis to triage health care resources...note: resources is used synonymously with treatment. The triage team would have the sole responsibility of performing triage and utilizing the triage model...not a easy job when you consider those people meeting certain criteria (high risk of death) may not receive access to those resources. According to the list, you would not recieve treatment (ie: access to health care resources) if you have a high risk of death and a slim chance of long term survival. The following list is offered to define high risk of death and a slim chance of long term survival:
People greater than 85 yeas of age
severely burned patients greater than 60 years
Those with mental impairment...Alzheimers's disease
Those with chronic disease...heart failure, lung disease, or poorly controlled diabetes...

So, if you meet the above criteria or you have one of those conditions, there may be no care for you in a disaster. What do you think about that?

Although I totally agree that health care resources will be limited (if available at all) and a disaster situation will require health care rationing of some sort, I think this report is short sighted and not grounding in reality. Here's what I mean...

This scheme is not too distant from current triage modalities with one major exception...in triage we always base our decisions on the situation and a set of triage priorities. It is safe to say that those we choose not to work on in a triage situation are not conscious and those that are will be treated as expectant...note that I said treated here.

Was there any concern for facility safety when establishing this list? How do you expect to handle a situation when a family member is denied treatment based on this list while others are given treatment? Let's put it this way: if health care resources are going to be short, it is likely that law enforcement will be in short supply as well. It is reasonable to expect that families will show up at a hospital or treatment center as a unit...with expectations and conscious.

Lists such as the one suggested by this report may violate age discrimination or disability discrimination laws...I guess its one thing to make a decision on who gets what during a crisis...yet another thing to put groups of people on a list ahead of time.

Finally, when the public outcry and debate over this occurs (and I surprised it hasn't yet) emergency managers and medical personnel alike will be required to justify these actions and this list. That is not to say the the proposed triage model is wrong...just the way the list is presented seems to be a sticking point. The fact is that triage and health care rationing will occur by default as there is no way our current health care systems will continue to function during disaster or crisis situations. Hurricane Katrina taught us that lesson...and we haven't done much about it yet.

The best approach to the situation of health care in disaster situations is to prepare. Simple to say, far more difficult to do. In all reality, those groups mentioned on the list will receive some level of treatment in a disaster. A better plan may be to prepare community resources outside the hospital systems and place emphasis on dealing with special needs populations including shelter-in-place actions.

Go Home, Everyone

I've recently had the pleasure of attending Courage to be Safe - So Everyone Goes Home. This program is offered by the National Fallen Firefighters Foundation and was delivered recently in my home town via the New York State Office of Fire Prevention and Control and was, simply put, one of the most meaningful presentations I've been at in the last twenty-four years.

This program, delivered by Mr. Paul Melfi, struck me at the core as a father, firefighter, and officer. I had the pleasure of interviewing Paul on the Courage to be Safe program while he was in Rochester. You can listen to the preview, my commentary and the interview with Paul on Mitigation Journal: The All-Hazards Podcast shows 60 and 61.Courage to be Safe - So everyone goes home is based on 16 Firefighter Life Safety Initiatives...everything from personal and organizational accountability for health and safety to apparatus design...are summed up in the 16 initiatives.

What are you prepared to do? Find your State Advocate here and request a class for your department...now, do it now. Not a fire-based organization? Courage to be Safe easily translates to emergency medical service.

Of course I have a few of the 16 Firefighter Life Safety Initiatives that stand out and have special meaning for me. Among my favorite initiatives are #4 All firefighters must be empowered to stop unsafe practices this means that the newest probie to the most senior officer have to have the guts to get out of the old mindset "because we've always done it that way" ...and that will take guts. This also means that we have to adjust our egos, actions and policy to reflect innovative safe thinking. When it comes to empowering your personnel to look for and stop unsafe practices, we have to think in the long term...a cultural change.

If your a chief officer or department offical - find your state advocate and request a class, if your a firefighter - forward this info to your chief and push this class to your brothers and sisters. It may be the best thing you can do to save a life.

Meth Labs and Propane Cylinders

A recent warning from the National Propane Gas Association highlights additional dangers from the production of methamphetamine.

Anhydrous ammonia is a common ingredient in the production of methamphetamine and adds to the growing list of hazards found at incidents involving meth labs. According to a release (no pun intended) by the National Propane Gas Association, anhydrous ammonia has been found to be stored and pressurized in consumer-grade propane tanks. The safety alert notes that anhydrous will corrode and deteriorate the brass service valves of a propane tank. The brass turns to a blue-green stain after exposure to anhydrous ammonia. There is no mention of time frame to failure/or quantity/concentration of anhydrous ammonia that will cause deterioration or failure of the service valve. It is noted that if the valve shows evidence of exposure to anhydrous ammonia it can't be trusted and it may be dangerous to move the cylinder. Valve failure may result in a violent discharge of the valve...resulting in injuries.

Many responders have been made aware of the dangers of meth lab incidents. We know to consider the chemical hazards as well and physical hazards at these locations and to be mindful that meth labs exist in nearly every jurisdiction, even on the highway. We also know to consider ammonia of various types in refrigeration and fertilizing operations, as well as in the residential setting as used for cleaning and disinfection in the commercial setting.

The issue of improper storage of anhydrous ammonia and the potential for service valve failure is just the tip of the iceberg. Propane tanks that have had anhydrous ammonia stored in them may be found in retail centers, craft stores, or any other location that offers a trade-in circulation for consumer-grade propane cylinders. This situation has to be added to your pre-planning and situational awareness.

Click here for the Safety Alerts page of the National Propane Gas Association. All photos courtesy of the National Propane Gas Association.