Price as an Air Transport Consideration

[Goose 188]

A number of things have started to get the gears turning and i wounder, should we ever include the price of air transport into the consideration process? Now, before anyone decides to go postal, I'm not talking about situations in which air transport is indicated. However, as we all know, air assets are likely overused in our respective areas. So, with that said, when you're making the decision to call for a helicopter do you ever consider the 8 - 10K bill associated with it?

Personally, its one of the factors that runs through my mind. Granted, its at the bottom of the check list. For me, when we are talking multi-systems trauma, its a no brainier if your a distance which merits a chopper. If you've got significant mechanism but a self extricated patient with arm pain and a lac on their forehead not only is a ground transport indicated and a better use of resources, but your also not taking your patient's wallet to town.

So, what are your thoughts?

[Guest partyrock]

I fully understand what your saying, and I use that though process when deciding ALS or BLS, but if you're at the point where you can consider cost as a factor for air txpt then the patient doesn't need it. Since the airmedical discussion was brought up a while ago I had a chat with one of the attendings at Jacobi about why so few patients are flown in. Simply put the vast majority of the times air transport from scene is unnecessary. Outside of exotic poisonings and the most sever burns and traumas ground txp or txp to a Level 2 is more than sufficient.

Edited July 6, 2007 by partyrock

[JetPhoto 626]

I agree Partyrock (what the hell is a partyrock, LoL) I don't care if the person is a bum or a millionaire, if the situation warrants it then I call it. To worry about cost at the time of need is discriminatory behavior. EVERYONE deserves the best care if it is warranted.

[JJB531 652]

I agree also... I think that sometimes aeromedical services are unncessarily used around this area because certain people want the excitement of calling the helicopter and don't consider the cost associated with it. Definetly if the patient fits the criteria for aeromedical services and there is a definite need for it, then absolutely put in the request.

[ems731 0]

I feel this is a great topic. I have heard stories and seen events where air transport has been called when the patient could have easily been transport by ground ambulance. I mean sometimes you could have been enroute almost to the hospital by the time the air transport reaches the scence, so to stay on scene longer and then throw in a big bill I think is a little much. Now I am not saying that when you get on a scene that might merit the use of air transport that the first thing running through your head should be the bill is not the case.

[helicopper 1,050]

It is an issue if the patient is discharged from the trauma center with little more than an emergency room visit being required (and this does happen) and the insurance company refuses to pay the exorbitant bill because it was medically unnecessary.

Another question is what happens to the bill when someone is transported for other than an MVA and does not have medical insurance? Are they receiving a bill directly?

Does anyone give the patient the option of being flown or going by ground? If they are conscious don't they have the right to be informed of, and provide consent for, such a decision?

[ailc307 1]

This very situation is what were dealing with now at my service. We have 2 helicopters in our county and usually no ortho at the hospital so we got into a bad habit of flying out fractures. Now with a couple of complaints from ER Doc's, we are looking at our scene flights a little more carefully, don't get me wrong if you need to fly we will fly you, but we are creating a checklist for our captains (who usually are the LZ ground contact) to go by, to critque our crews and if the patient met flight criteria. Then there is really no question about it.

[smwells 7]

Are we going to delay transport to play 20 questions? Are we going to wait to launch the helicopter until we are on scene?? Can the patient truly judge if the helicopter will provide better care, or the EMS personel? I agree the that it is over used, but I would rather get them in the air and cancel them, than need them and delay required care.

I recently worked a motorcycle accident on the tsp (no surprise), the helicopter was launched prior to the ambulance arrival at the direction of the FD on scene, once the patient was evaluated by BLS/ALS a ground trip would have been fine, but statflight was on the ground already. In many cases the launching of the helicopter is based upon the dispatch information, and MOI.

[Guest alsfirefighter]

Goose I get what your saying bro. Cost/insurance/finances are of course never a deciding factor...period. It is simple if they warrant transport per criteria/protocol then use it. If they do not don't use it. I don't know what it is with agencies that can easily ground transport but they fly, there is nothing happening in that helicopter that couldn't in the back of an ambulance, except a very few things. Its not cool, there's nothing more to it. You have to combine patient presentation, assessment, MOI in conjunction. I have seen and heard too many providers and fire service responders arrive on scene and call for helicopter based on how the vehicle looks. MOI is imporant yes, but how about getting a grip on the patient. With today's vehicle construction and safety features minor accidents look much worse, crumple zones giving, airbag deployments etc are keeping us safer in vehicles. If your not sure of yourself, look for training or ask. If you're close enough to drive...drive. If anything because someone farther out of the med center ring might actually need an air transport.

As a joke I often say to providers when having candid discussions on certain decisions those make on flying out. When asked what the patient's injuries were the provider usually goes down the list of this and that and if we (and we usually do) find out the person was discharged within hours or after a short observation period my standard reply is usually:

Yeah all that and the biggest injury was to his wallet....for a unnecessary air transport.

It usually gets a few giggles and is a good joke amonst the thicked skinned.

[Guest partyrock]

Are we going to delay transport to play 20 questions? Are we going to wait to launch the helicopter until we are on scene?? Can the patient truly judge if the helicopter will provide better care, or the EMS personel? I agree the that it is over used, but I would rather get them in the air and cancel them, than need them and delay required care.

I recently worked a motorcycle accident on the tsp (no surprise), the helicopter was launched prior to the ambulance arrival at the direction of the FD on scene, once the patient was evaluated by BLS/ALS a ground trip would have been fine, but statflight was on the ground already. In many cases the launching of the helicopter is based upon the dispatch information, and MOI.

Absolutely call the bird if you think you might need need it, but once you determine its not needed cancel it. If its all ready there, thank them for their services and send them on their way. For some reason it seems that people think once the bird gets there you have to put the patient on it. You don't. You can sit the bird there all day long and keep on driving pt's past it to the ER if the services they offer are not necessary.