The reality around life-threatening medical assistance at BITD

deano

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Good to know. I will be sure to let Jim McCoy and Rob Hackett know they have done the impossible; multiple times. I always knew they were good, but now I know they are legendary!!

Super proud they choose to be associated with our team.

Exactly what I thought when I read the Bro-Gill comment .. Jim and his R44 was very instrumental in transporting our good friend Jeff "Ox" Kargola off the Baja desert dirt floor to a Hospital in San Felipe (all 6'2" of him) for his life threatening injuries - He unfortunately passed away while in the hospital, but needless to say that the R44 helo absolutely was the "right" airship for that day and Jim was spot on, on the rescue. Thank you Heli-Jim
 

Bro_Gill

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Mark- I ain't making it up...

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DoitforBMoore

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Mark- I ain't making it up...

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The reason Robinson helicopters have more crashes out there is because there are WAYYYY more of them in public then any other ship. On top of that its a training helicopter because is affordable to fly. They have their purpose. I've flown in them ALOT. with Jim as well.

Would I use it for medical. No probably not. Can it be used for medical? Yes. But you wont be landing on diablo dry lake bed when its 118 out side..

Robinsons are cheap. 600 ish a hour and cheaper Vs a Long Ranger or Astar that can be from 1200-2000 an hour
 

tapeworm

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Exactly what I thought when I read the Bro-Gill comment .. Jim and his R44 was very instrumental in transporting our good friend Jeff "Ox" Kargola off the Baja desert dirt floor to a Hospital in San Felipe (all 6'2" of him) for his life threatening injuries - He unfortunately passed away while in the hospital, but needless to say that the R44 helo absolutely was the "right" airship for that day and Jim was spot on, on the rescue. Thank you Heli-Jim

If you could use a Honda Civic to transport a seriously injured person to a hospital or an ambulance which would you use?

Just because an R44 has worked multiple times doesn't mean it's the right helicopter for the job. I don't even think their are any R44's that are medically certificated by the FAA.

Look up the normalization of deviance. You are falling directly into it.

I only have 10 years of fire and ems experience, 5 of which has been on a helicopter, so I'm nowhere close to experienced but if I were trying to put together a medical helicopter support program, an R44 would be my second to last choice, right before the R22.

I work on super hueys, which is a heavily modified version of the Vietnam UH1H helicopter. We have literally exhausted all aftermarket options for our particular platform to make it perform any better. At 100 degrees ambient air temp, at 700 feet of elevation, we are only able to carry 7 people, 250 pounds of gear, and an hour and a half of fuel. That's in a platform that is easily able to carry 10 times the amount an R44 can.

Again, just because it has worked when no other option was available, doesn't mean it's the right tool for the job.

The effort you are putting into this is commendable. You have stepped up and provided a great service and that is something to be proud of, but don't let luck mislead you into believing that you have found the best option. The R44's worked when their were no other options available, but this discussion right here is meant to bring much much better options to the table so we aren't using the Honda Civic (R44) to take people to the hospital, but instead an actual medical helicopter (ambulance).


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Bro_Gill

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Dan, you don't get it. If and when one goes down transporting a patient it isn't carded to carry, are you going to represent Mark in the court case?
 

dan200

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Dan, you don't get it. If and when one goes down transporting a patient it isn't carded to carry, are you going to represent Mark in the court case?

I would totally represent him in court but it would probably be better for him if he hired someone who went to law school. I think my defense plan would be to "put the system on trial" which should be a solid platform.

Respectfully, Doesn't the "Good Samaritan" act help in these situations?



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Honda48X

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I would totally represent him in court but it would probably be better for him if he hired someone who went to law school. I think my defense plan would be to "put the system on trial" which should be a solid platform.

Respectfully, Doesn't the "Good Samaritan" act help in these situations?



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The good Samaritan act absolutely fits that situation. I'm a Deputy Fire Chief and I would be more than happy to sit on the stand and say they tried their hardest to get the person to the care that was needed. Thank you Mark for having a helo in the area. If I was having a heart attack I really don't care what helo it is.
 

vegasloki

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I would totally represent him in court but it would probably be better for him if he hired someone who went to law school. I think my defense plan would be to "put the system on trial" which should be a solid platform.

Respectfully, Doesn't the "Good Samaritan" act help in these situations?

If you are stopping to help someone that's one thing, you're likely good to go. In NV you need to be part of an official search and rescue team working under a local sheriff to be covered if you are transporting a victim. The scope for just helping until they arrive is a bit more broad. The details are at NRS: CHAPTER 41 - ACTIONS AND PROCEEDINGS IN PARTICULAR CASES CONCERNING PERSONS . If someone was operating in good faith and lifted them out and were later sued by the family it would be a pretty douche move but stranger things have happened.

If it's advertised as available to be used as an air ambulance, for example the TT association is getting some funding/reimbursement from the sanction for the helos or the entry charges to reimburse the helos it's going to be an issue. If nothing else due to not being legal to operate as an air ambulance under NV law. Someone might even say that since the sanction knew that was happening they looked the other way to avoid paying for a designated air service they were liable and if the teams were accepting reimbursement or payment they could be liable as well.

The reality is the sanction needs to provided licensed air services on standby and not rely on the good fortune of the race teams.
 

ndvalium

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Good to know. I will be sure to let Jim McCoy and Rob Hackett know they have done the impossible; multiple times. I always knew they were good, but now I know they are legendary!!

Super proud they choose to be associated with our team.

Without a doubt Mark, your helicopter assets and team have made a difference in people lives. Don't get caught up in anything else related to that. You have had a positive impact and as one of those charged with answers to challenging solutions, I am appreciative of all the help they have provided and have zero doubt that they will again in the future. On behafl of myself, my team and all of BITD - Thank you sincerely for your efforts.

The R44's worked when their were no other options available, but this discussion right here is meant to bring much much better options to the table so we aren't using the Honda Civic (R44) to take people to the hospital, but instead an actual medical helicopter (ambulance).


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This is my focus and recommendation to BITD for Vegas to Reno 2018 - I think I have a good plan for it that will meet our needs. By utilizing resources from both Nevada licensed helicopter air med providers, we will not only have multiple assets with us at the race, but immediate coordination of additional resources should they be needed.

I would totally represent him in court but it would probably be better for him if he hired someone who went to law school. I think my defense plan would be to "put the system on trial" which should be a solid platform.

Respectfully, Doesn't the "Good Samaritan" act help in these situations?



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The good Samaritan act absolutely fits that situation. I'm a Deputy Fire Chief and I would be more than happy to sit on the stand and say they tried their hardest to get the person to the care that was needed. Thank you Mark for having a helo in the area. If I was having a heart attack I really don't care what helo it is.

Honda, I don't believe this issue is as cut and dry as what you are stating. Is it the right thing vs is it the legal thing are very different. While I wish life was 100% dependent on the right thing, it isnt. I watched and participated in several court cases already against BITD since I took over the role as Medical / Rescue Director in 2010. I wont need a colonoscopy for many years....

Here is one of the problems with personal Medics, Nurses or whatever in a personal helicopter. Good Sam laws stop the second you perform skills outside of your license. A Paramedic / Nurse is only a Licensed Paramedic / Nurse when working for the service they are hired for in performance of their duties. They have a medical director, and are licensed for that state to perform their skills under that state. A Paramedic / Nurse that happens to have their "own" IV fluids, medications or other advanced interventions and "happen" to come across an injured individual and utilize those interventions is violating state law as well as the conditions of their license. These folks when not performing services for their licensed agency by law can only perform as Basic level responders.

If the helicopters utilized nothing but basic life supportive care, they could easily be covered and assist as they come across something in the dirt. Most teams however do not.

Now while I haven't explored this option yet, we might be able to bend a few rules for basic IV fluids and some advanced medications by putting them on our roster at Motorsports Safety Solutions. We have a medical director we operate under and we might be able to stretch that to the EMT advanced level for them. In Nevada that does offer a decent scope of practice but I have to see how that works in the licensing aspect. this could potentially allow them to perform an Advanced scope of skills while waiting for a licensed transport vehicle.

To take it a step further, Good Sam is typically applied for volunteers and situations that you come across something and jump in and help. While I am in no way a lawyer, I would speculate that a Medic / Nurse, with a jump bad, advanced interventions, that responds for a request for help, might not be something that is covered in Good Sam regardless if they are paid or not. The moment they perform a advanced medical intervention, and then transport the person, they absolutely are not covered under Good Sam. They are then performing as an air ambulance service in a heavily licensed and regulated industry. Are their times that may need to happen? Absolutely, and like Mark said - if that is the call in an emergency, then myself, our medical director and BITD will support it.

Looking at what happened at V2R, it was a completely "freak" situation. Quite frankly in my 28 years I have never had this situation happen as far as the injury Chris received. I don't think a Trauma Surgeon witnessing this incident could have made a difference in this case. Menzies helicopter made a decision in a life threatening situation and we stand behind the choices they made regardless of the outcome.

My direction is much different for BITD as it makes sense to me; If there are going to be dollars spent on this, we will get a licensed service capable of performing everything possible for our racers in the proper platform for that service. The cost has gone down substantially from the quote 3 years ago and I think with this option, we will end up with the best coverage possible in this area. My vision for 2018 involves A helicopter covering start to Tonopah for Bikes and Quads and then returning to start for Cars and Trucks. Meanwhile a second helicopter covers Tonopah to Fallon for bikes and then return to Cars and Trucks. If one of the stand by ships has to leave to transport a participant, these helicopter companies have additional helicopters available to back fil and continue stand by for our event. This plan has a few variables however that are not determined with most of all being, potential changes to how the entire event is run with trucks now catching bikes so early in the day. There have already been numerous discussions on these issues. Changes are coming for sure though to this event for 2018.
 

Bro_Gill

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Thanks Dave. For those that have worked in the EMS and Emergency environment and have seen the difference from Joe Shmoe on the street to Doctors on Duty in the ER, the rules that apply are different. I appreciate you doing this right. Good Sam laws are different if you are a trained responder versus just some guy who happened by. You can be a paramedic that works on a transport helo for your profession, but the minute you are not on duty, you are a simple EMT Basic/1 and cannot operate beyond that scope of practice unless there is another person of the same or higher level of training and they are willing to let you operate under their license. Mexico may be different, but the rules apply in the U.S. I understand that teams want medical folks available and hire/have volunteers that go with their teams, but the second they offer this out to others creates a headache for you and BITD. And I think they don't get it because they haven't had to live in that world.
 

vegasloki

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In NV if you are an NV licensed medical professional or firefighter (including volunteer) and happen upon someone that needs assistance you can operate within the full scope of your licensing and be covered under the conditions of the Good Samaritan law.
 

ndvalium

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In NV if you are an NV licensed medical professional or firefighter (including volunteer) and happen upon someone that needs assistance you can operate within the full scope of your licensing and be covered under the conditions of the Good Samaritan law.

So the Southern Nevada EMS director is a long time friend of mine. I sent her the situation:

Her response and this is for the entire state-

If someone is not "on the clock" they are not licensed, they are only certified, and therefore are forced to perform at a non invasive first responder level only. Good Sam only covers the first responder level which is basic first aid and cpr. No iv access or airway management other than basic adjuncts.


So that seems to conflict with your belief. Can you point me to your info source?


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vegasloki

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So that seems to conflict with your belief. Can you point me to your info source?

Sure... It's the text from the Good Samaritan law, NRS 41.500 NRS: CHAPTER 41 - ACTIONS AND PROCEEDINGS IN PARTICULAR CASES CONCERNING PERSONS In the entire text of the reg there is no mention of on or off duty. Perhaps they have an internal reg that prohibits anything but basic though the NV law doesn't mention it.

This one is for firefighters.. 41.500 (5)

5.  Any person who is employed by or serves as a volunteer for a public fire-fighting agency and who is authorized pursuant to chapter 450B of NRS to render emergency medical care at the scene of an emergency is not liable for any civil damages as a result of any act or omission, not amounting to gross negligence, by that person in rendering that care or as a result of any act or failure to act, not amounting to gross negligence, to provide or arrange for further medical treatment for the injured or ill person.

Here it is for docs, nurses, attendants and the like both giving and receiving instructions NRS 41.504(1-3)...


1.  Any physician, physician assistant or registered nurse who in good faith gives instruction or provides supervision to an emergency medical attendant, physician assistant or registered nurse, at the scene of an emergency or while transporting an ill or injured person from the scene of an emergency, is not liable for any civil damages as a result of any act or omission, not amounting to gross negligence, in giving that instruction or providing that supervision.

2.  An emergency medical attendant, physician assistant, registered nurse or licensed practical nurse who obeys an instruction given by a physician, physician assistant, registered nurse or licensed practical nurse and thereby renders emergency care, at the scene of an emergency or while transporting an ill or injured person from the scene of an emergency, is not liable for any civil damages as a result of any act or omission, not amounting to gross negligence, in rendering that emergency care.

3.  As used in this section, “emergency medical attendant” means a person licensed as an attendant or certified as an emergency medical technician, advanced emergency medical technician or paramedic pursuant to chapter 450Bof NRS.

There's another one a few down from this that allow docs, nurses and PAs licensed from anywhere to be covered. I don't think any of that negates the need for pros on standby at the event rather than relying volunteers or someone from one of the teams. It's good they can help but they shouldn't be the first line.
 

Bro_Gill

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The issue arises in that everyone below doc/PA/Registered Nurse practices their advanced care under someone else's license. Doctor's can basically do whatever they want in trying to save someone, including non-normal procedures. That is what their license allows. The PA or Nurse also have a lot of leeway, but not quite as much. Just about everyone else enters the realm of advanced medical procedures after conferring with one of the above via phone/radio/electronic device. It has changed a little somewhat over the years with more procedures being allowed prior to base contact, but there are still limitations. That is what doing anything beyond the allowed BLS skills crosses the line for most states when you are no on duty. And the Good Sam laws protect up to Basic Life Support skills (i.e.- the skills you can practice while working and not making base contact to go farther). Once you enter the ALS skill level, you must be working under a physicians license/access. Doing so removes the Good Sam protections and places you back into the professional side where malpractice comes into play. We all want to do the right thing, but those that have a license to do more than the basics have to know the limits or else lose that license and be held criminally and civilly liable if something doesn't work out in the end. The case that blew this all out was a nurse in L.A. who came to the aid of a woman trapped in her car after smashing into a tree. The nurse removed her from the car. The women became paralyzed and a lawyer sued the nurse fr violating her medical care standards. She did not apply spinal immobilization or place the woman into a position protected her spine. Whether that had anything to do with the outcome didn't matter. The nurse lost the civil case because she did not act within the basic medical skills she was allowed to under Good Sam.
 

ndvalium

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Sure... It's the text from the Good Samaritan law, NRS 41.500 NRS: CHAPTER 41 - ACTIONS AND PROCEEDINGS IN PARTICULAR CASES CONCERNING PERSONS In the entire text of the reg there is no mention of on or off duty. Perhaps they have an internal reg that prohibits anything but basic though the NV law doesn't mention it.

This one is for firefighters.. 41.500 (5)



Here it is for docs, nurses, attendants and the like both giving and receiving instructions NRS 41.504(1-3)...




There's another one a few down from this that allow docs, nurses and PAs licensed from anywhere to be covered. I don't think any of that negates the need for pros on standby at the event rather than relying volunteers or someone from one of the teams. It's good they can help but they shouldn't be the first line.


Ok - That what I thought you were referring to - Nothing in any of that pertains to level of certification and Advanced interventions. As the State of Nevada EMS office holds one of my licenses, I am will defer to the State EMS director that says it is violation of my license. That was actually the entire reason I started my own formal company doing this was to allow us more that first responder level care to racers. I wanted the ability to perform advanced care under a medical director
 

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I'm ASSuming you have an attorney to consult. My understanding dealing with Clark County is that SNMD only covers Clark County, Carson City covers the rest. For example Nye County doesn't even have a health department. I think it's great you err on the side of caution. However I can't find anything in the SNMD regs regarding EMS services or the NRS relating to either reduced services or exemption from the current law. The health district isn't going to be the one deciding it anyway. That sort of tort will go through district court in the county where it occurred.

The issue Bro_Gill brought up in Cal is different than how the law is written in NV. In CA the court decided that the waiver was good only for medical care due to how it was written. The court then decided that a rescue (the one that damaged the ladies spine) was not medical care. That in turn caused the CA leg to rewrite the law but it's still considered weak compared to the law in other states.
 

ndvalium

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I'm ASSuming you have an attorney to consult. My understanding dealing with Clark County is that SNMD only covers Clark County, Carson City covers the rest. For example Nye County doesn't even have a health department. I think it's great you err on the side of caution. However I can't find anything in the SNMD regs regarding EMS services or the NRS relating to either reduced services or exemption from the current law. The health district isn't going to be the one deciding it anyway. That sort of tort will go through district court in the county where it occurred.

The issue Bro_Gill brought up in Cal is different than how the law is written in NV. In CA the court decided that the waiver was good only for medical care due to how it was written. The court then decided that a rescue (the one that damaged the ladies spine) was not medical care. That in turn caused the CA leg to rewrite the law but it's still considered weak compared to the law in other states.

Much of my responses are specifically driven based on the court cases I have had to participate in with obvious support from legal beagles.

Nye County is covered through Carson City - but has a state rep that meets us in Tonopah - That is where I have to go through inspection each year to maintain our advanced abilities.

I spoke to the State EMS director yesterday as well - same answer - If not working for an agency, there is no ability for advanced interventions. It is cut and dry from the EMS office perspective. They hold my EMS licenses so that is who I answer ultimately to. - To take it a step further, it is a misdemeanor to even possess needles and medications unless you are working for an agency in performance in your duties. Depending on the medications that someone may be carrying from normal saline to whatever it ranges from misdemeanor to felony. Even a simply IV cath required a physician prescription to possess. We operate under two medical directors. My company has a med director that is very high in the state level and we have the BITD Medical Director that is actually present at all events.

Anyway we wandered far from the topic - I know my team is operating legally in support of Best in the Desert. I will continue to maintain only what the states of Az and Nv recognize as legal solutions for our racers while we are there. What other teams choose to do to support themselves is up to them and what other racing organizations choose to do is ultimately up to them as well.
 

deano

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If you could use a Honda Civic to transport a seriously injured person to a hospital or an ambulance which would you use?

If the Honda Civic is all that was available while your good friend is dying on the Baja desert floor, it doesn't matter what the F the transport vehicle is. Time and any mode of transportation are the top priorities at that point - Sure, a nice plush Medi-vac helo or an a/c cooled ambulance would be the top choice .. Go re-read my post again and comprehend that I was applauding Jim and his R-44 at that particular rescue, not every rescue ...
 
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