Friday 29 March 2019

Air transport

It should surprise exactly no one that most of my patients come to me by ambulance. There are a few walk-ins (walks-in?) - mainly 1) folks who are assaulted and have fractured noses and/or mandibles, 2) people who wake up having blacked out drunk the night before with have no fucking clue why the hell their head is bleeding, or 3) cars that roar up to the ambulance bay, kick some bleeding kid out of the car, and roar back off. Patients in categories 1 and 2 are usually not injured enough to call an ambulance, but they are still injured enough to warrant my attention once they get to the hospital, while patients in category 3 are usually dead or dying and need my attention an hour ago.

And then there are the people transported by helicopter.

Since my hospital is the only trauma centre for a very large portion of the surrounding geography (much of which is rather rural), it would simply take too long for a regular ambulance to navigate traffic, so they are flown in. The rural area and the people who live there are . . . well, let's just call them different. I won't go into detail, because I am not disparaging these people, and because I think everyone reading this, no matter what part of the globe you occupy, has that area very close by where the people are just a shade disparate. Admit it, you know exactly what I mean.

Unfortunately it isn't just the general population that is unique, but the doctors as well. 

Henrietta (not her real name™) was a very sweet 72-year-old woman who was brought to me by air ambulance after a fall. Most falls in elderly people are ground-level falls (sorry all you 70+-year-olds out there, but yes, you're elderly), but Henrietta was a bit different. Not different, just different. She had fallen off a bed. Now I get falls from bed all the time (unfortunately), but again Henrietta was different. Because the bed she had fallen off wasn't so much a bed, but more of a table.

A CT scanner table.

I'll pause here so you can reread that last sentence fragment again.

If your head is spinning like a CT scanner and you're wondering just what the hell you just read, then you can rest assured that you read it correctly.

Henrietta had been at an outpatient radiology centre located somewhere very close to the Ass End Of Space and was getting a CT scan of her brain for reasons known only to her doctor (apparently). I asked her several times why she was getting her brain scanned, but her only response was "My doctor told me to". [Note to everyone out there: if your doctor instructs you to get a test done, any test, make sure you ask WHY.]

Anyway, Henrietta had become a bit restless and anxious while the CT tech was adjusting the table and had rolled off and bonked (that's the technical term) the back of her head a bit. She did not lose consciousness, was acting completely appropriately, and had no complaint other than the mild head bonk.The radiologist was concerned (for some unknown reason) that she had a brain injury, so he did the correct thing to do in that situation, which was absolutely nothing different than was already planned. Since she was there for a brain scan anyway, he simply got her up, put her back on the table, did the scan she was supposed to get, and let her go home after reading her scan and making sure her brain was uninjured.

HAHAHAHAHAHAHA no he didn't. He didn't do any of those things. No, with a neurologically normal patient and a CT scanner literally at his fingertips, he called a fucking ambulance.

Yes, really.

Twenty minutes later the medics arrived and assessed her. It seems they were inexplicably just as concerned as the radiologist, because they also felt she needed a full trauma workup. But because the radiology centre was located near the Restaurant At The End Of The Universe, they called for an air ambulance.

Yes, really.

The helicopter brought Henrietta to my trauma bay about an hour after the incident. This included the time for the ground crew evaluation, the helicopter taking off, flying, landing, packaging her up, inserting her into the bowels of the helicopter, taking off again, flying again, landing again, and unpacking her at my hospital.

I'd just like to take a brief moment to recap for anyone who may have gotten lost: a helicopter brought a woman from a CT scanner, where she was getting her brain scanned, to me, so that I could put her in a CT scanner and scan her brain.

Incredulity just barely scratches the surface of every single person in the room as the transport crew gave us their report, which sounded a little like this:

"Hi there (sorry) Doc, this is (really sorry) Henrietta. She (seriously, we're sorry) rolled off a CT table and hit her head (so sorry)."

Henrietta was still acting completely appropriately, though she had a slight headache and a very small bump on the back of her head. After approximately 623 confused glances were exchanged among the hospital staff and the helicopter crew ("Hey, they call us, we come", they said in their defence as they left), I did a thorough head-to-toe evaluation and then, you know, scanned her head.

And wouldn't you know, it was absolutely, completely, totally, and in all other ways stone cold normal and gave exactly no indication as to why she was getting the original scan in the first place. About two hours later, Henrietta's husband arrived after navigating traffic from Bumfuck Nowhere. Notably, he had no idea why she was getting the original scan either. Regardless I made sure to give them copies of her scan to give to her doctor.

I also sent a copy of both the scan and our radiologists' report to the referring radiologist at the outpatient imaging centre. I strongly considered attaching a note that said "Here is what you would have seen had you not wasted an absurd amount of time and money and had instead just done the right goddamned thing", but my restraint came through in the end and I thought better of it. Instead, my note simply said,

"Henrietta's brain. Normal".


  1. So what's the problem? They did their job and you were lucky enough to do yours. What's the problem? You want to make a federal case out of this and repeal ACA?

    1. the problem is they used up several man hours of time and spent thousands of dollars transporting a patient from one CT machine to another. and telling an anonymous story about it is about the right level of response to it.

    2. It would be a cobra violation if they had done nothing you genius.

    3. WTF is a cobra violation? all that comes up on teh interwebz is when your health insurance company denies you the opportunity to self fund your group plan for up to a year until your new job's plan takes effect.

    4. Lol. Is that the only cobra violation that you know of? Bahahahaha.

    5. I suspect it is one more than you actually know of. unless you're into reptiles.

    6. and to get back on topic, it would have been SOUND PRACTICE if they had proceeded with the CT scan THEY WERE ALREADY PLANNING ON DOING.

  2. reminds me of the first off-airport LZ I secured for the (at that time) air ambulance company. now, each air ambulance company has their own standard for an LZ, but the rudiments are the same - make sure nobody gets in the way of the bird, and be ready in case something goes horribly wrong.
    so we get a call to establish an LZ at one of our preidentified alternate sites. and then the kicker: "fuel is an issue"

    so I grab a quick response unit, and hustle off to secure the area, which for this company basically involves parking the apparatus with its tail into any significant wind that way the pilot can land facing the apparatus. (at night, you would illuminate the area with the headlights until the pilot tells you to go dark, and then he lands on light amplification)
    so, all this accomplished, the helicopter arrives and lands in about as boring a process as helicopter landings ever go. an ambulance shows up to pick up the special backboard that model of helicopter uses, so they can return with the patient already on the backboard.
    while we wait for the patient to arrive, we have a very nice chat with the pilot on what specific things to do in case the whole world goes sideways, which is good to know, just in case. oh, and we ask about his fuel. "oh, we've got an hour of reserve fuel available. not sure why that thought that was an issue."
    finally, the ambulance gets back with the patient, and we get everybody assembled into the helicopter that is going. (that model carries the driver, the flight attendant - er - nurse, and the patient)
    finally, as the helicopter disappears over the horizon, I ask the ambulance crew, "so what's he going by air for?"

    "oh, it's just a scheduled checkup, but we didn't have a car available to take him by ground."

  3. How could you possibly have named her Henrietta instead of Abbie. Poor show.

    1. it took me a full day to see what you did, there.

  4. I highly appreciate your restraint. I didn't know if I were you how I would handle this!


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