Air Ambulances Under Fire - Overused? Few benefits?

[Guest]

WAS967 already posted a story addressing the use of air amb but, it looks like this is being picked up by other papers. It surprised me to see this article in the Wall Street Journal (of all places) and their focus is on this:

--- Do air ambulances benefit most patients from a cost/benefit ? All these experts they quote talk about ground transport being generally faster. I'm no expert but, just because we had 3 crashes this year (nationwide!) should the whole concept be under fire??? Overkill??!!

March 3, 2005  

   

Air Ambulances Are Under Fire

Critics Say Emergency Medical Helicopters

Are Overused and Offer Few Benefits to Patients

By KEVIN HELLIKER and VANESSA FUHRMANS  

Staff Reporters of THE WALL STREET JOURNAL

March 3, 2005; Page D1

For weeks now, federal regulators have been investigating the safety record of the air-ambulance industry, which has experienced four deadly crashes this year.

But an increasing body of evidence suggests there is a larger question to be asked about emergency-medical air transports: Do they benefit most patients?

The conventional wisdom is that air ambulances save the lives of patients who are too critically ill to withstand a slower ride in a ground ambulance. Yet some observers of the industry say medical air transports actually save very few lives -- while costing as much as 10 times more than ground ambulances.  

A number of published studies including research at Stanford University and the University of Texas, show that the flights often transport minimally injured patients when ground transport frequently could get them to a hospital faster, and with less risk to others.

"In 20 years of experience in urban critical-care helicopter transport, I can count on the fingers of one hand the number of times I thought flying a patient to the hospital made a significant difference in outcome compared to lights and siren," says David Crippen, an associate professor of critical care and emergency medicine at University of Pittsburgh Medical Center.

Some research on medical air transports:

• A 2002 paper showed a 24% reduction in mortality for seriously injured patients, but nearly 60% of patients actually had lesser injuries.

 

• A 1995 study of potential organ donors flown by transport found that an estimated 27 out of 28 would have arrived faster by ground ambulance.

 

Inspired by images of helicopters evacuating wounded soldiers in Vietnam, the air-ambulance industry took root in the 1970s and has grown steadily ever since. The industry fleet has nearly doubled since 1997, and patient transports are rising an estimated 5% a year, according to Tom Judge, president of the Association of Air Medical Services, a trade group.

The current probe of this year's fatal crashes, begun in January, comes as the industry has drawn increasing scrutiny over not just safety, but also efficacy and possible overuse.  

Also in January, the journal Prehospital Emergency Care published an abstract reporting that a study of 37,500 helicopter-transported patients determined that two of three had only minor injuries. One of four had injuries too minor to require hospital admission. "The evidence says too many patients are being flown, and yet they keep flying more," says Bryan Bledsoe, a physician who co-authored the Prehospital Emergency Care abstract.

Among other recent research critical of air-transport use, Stanford University trauma surgeon Clayton Shatney conducted a study of 947 patients flown to Santa Clara Valley Medical Center and concluded that helicopter service potentially saved the lives of only nine of them -- while potentially serving as detriment to five who could have arrived faster by ground.  

Travel by helicopter often is slower in urban situations, in part because of a lack of places to land. "In multicasualty situations, it has not been uncommon that ground ambulances arrive before an airship with patients from the same event," says the Stanford study, published in 2002 in the Journal of Trauma, Injury, Infection and Critical Care.

Critics say air ambulances are overused and offer few benefits to patients

 

To be sure, there are situations where there is little debate that medical air transport has clear benefits, such as in rural areas where patients must travel long distances quickly.  

Some smaller hospitals that fly patients to bigger facilities say they must err on the side of caution with a patient they aren't equipped to handle themselves. And there is research that shows a value for patients.

A 2002 study, conducted by an air medical service in Boston compared patients flown with patients driven and showed a 24% survival benefit among the most seriously injured who were flown. "That's an enormous benefit," says Mr. Judge of the Association of Air Medical Services.

The cost of air ambulances varies -- generally from $5,000 to $10,000 a trip, and sometimes as much as $25,000, according to industry experts. That is typically five to 10 times as much as ground ambulance.  

But ground transportation also can be not just less expensive, but faster: A 1995 study of air transport of potential organ donors in Houston, conducted by trauma surgeon Christine Cocanour, found that 27 of 28 would have arrived faster by ground ambulance.

[LCFD994 8]

Interesting article, I guess the writer was never strapped to a board and had a 20 minute plus ride to a facility.

I can note on two different areas of the State. Where I work in Lower Westchester, we rarely use a MEDEVAC to the scene, we have transport times, I am talking once the patient is in the back of the ambulance, of 5 minutes to a Level 2 Trauma Center, and about 10-15 minutes to a Level 1 Trauma Center.

Now where I work in Putnam County, there are ground transport times of 20-30 or more minutes depending on where you are, time of day, weather, etc.etc.etc...and that is only to a Level 2 Trauma center in either another state or in dutchess.

Do I feel a MEDEVAC is always needed, of course not, and I know of certain Medics that absolutely, positively abuse the system and call the MEDEVAC all of the time, and this is part of the problem.

The cost dosent play into the factor for my decision to call one or not. As most Medics would say I am looking out for the best interest of my patient.

The system here in the Hudson Valley isnt perfect but it is what we have now, and have to deal with.

I do know that when I started EMS, there was no MEDEVAC system available to us, and we used to take those " criticaly injured " patients to the closest hospital and most of them died. So i feel there is a place for the MEDEVAC if it is used properly.

[Guest WolfEMT]

Air ambulances may have what seems a prohibitive cost, but in my opinion, the benefits far outweigh the shortcomings such as price. I posted an IA about two weeks ago which described an MVA with entrapment. The entrapped passenger was flown to a trauma center where he had emergency brain surgery within 10 minutes of landing. From the accident scene, ground transport to the trauma center would take roughly 20 minutes; air transport, however, took only 2 to 3 minutes. I do believe that the air ambulance that took the patient to the trauma center was a crucial part in saving his life.

As far as the cost, the insurance companies and patients do not receive a bill for medevac services in the State of New Jersey. The cost of maintaining the NorthStar and SouthStar fleet is factored into the property taxes of state residents who own property; it only raises the property tax 0.5 cents per assessed $100,000 value of property. Does NY State have a similar way to pay for its medevac helicopters? If not, would it be more cost effective to switch to the NJ model?

[WAS967 97]

A 2002 study, conducted by an air medical service in Boston compared patients flown with patients driven and showed a 24% survival benefit among the most seriously injured who were flown. "That's an enormous benefit," says Mr. Judge of the Association of Air Medical Services.  

Sounds a little biased to me.

I work mostly in the Northern Westchester area. I don't often use helicopters unless we're out in the Pound Ridge/Vista/North Salem side of things and need to get someone to WMC quickly for specialized care (neuro/burn/peds/etc). From a majority of the areas I work (From the Hudson to the Reservation) I can get the patient to the hospital quicker than the helicopter. I had a call in Somers with at least 3 patients all going to the medical center. I remember one of the was a pediatric with a shoulder fracture/dislocation. [Ed, you probably remember this one]. The chopper was landed at Whitehall Corners for one patient. I took another patient by ground at about the same time. I and the other ambulance with the kid got there before the helicopter did. 1) The helicopter has a lot more safety to consider and takes a little more time to load the patient. 2) The crew has to walk all the way from the opposite side of the hospital to the ER (which is now significantly further with the new TER being where it is and the new pad nowhere near opening) and 3) Sorry guys, but some of the crews have this aweful tendency to putz around on the scenes. We had one medic almost tell the crew to get going or he was going to take the patient care back and go by ground.

Oh, and the only other reason I might call is if I suspect the patient might need RSI. It's unfortunate we don't have the ability ourselves. And I doubt that will change anytime in the near future.

[x635 4,066]

A 2002 study, conducted by an air medical service in Boston compared patients flown with patients driven and showed a 24% survival benefit among the most seriously injured who were flown. "That's an enormous benefit," says Mr. Judge of the Association of Air Medical Services. 

Sounds a little biased to me.

Not really. Although I agree from most points in Westchester, including Vista, you can get patients to a trauma center (Norwalk, Danbury, Stamford, Jacobi or even Westchester), the situation is not the same in Boston.

All of Boston's trauma centers are centrally located within the city. Due to the large volumes of traffic and road conditions in the city of Boston, and in the outlying suburbs, it is often faster to fly the patient in then try to drive. Sometimes, if your at Route 1 in Saugus which is pretty much a straight shot into the city, you can get in in 10 minutes by ground, that same trip could take you 25 minutes during rush hour.

Plus, Boston Medflight is a top notch program, and has some excellent (and fast) staff. It's a world of difference between them and Stat Flight.

http://www.bostonmedflight.org/

Also, having worked/interned for a helicopter program recieving facilty, I have seen patients come in by helicopter that made it barely that probaly would have died during a ground tranport.

Another problem with Air Med helo's is the fact that people abuse them. They think just because it's a big job, even if the patient has minor injuries, that Stat Flight is always needed no matter what, and don't take any other factors, such as ground vs air time, into consideration.

Suburbs, maybe not so much a neccesity, with exception of special circumstances. Rural areas, a helicopter is a neccesity.

[Guest]

Approx 10-12 yrs ago I recall Stat Flight was called for a PIAA on the Sprain Brook Pkwy S/B at RT 287- That's Approx 1-1 1/2 miles to Westchester Medical Ctr. That was probably misuse of system, but then again I wasn't there on scene. Just a thought.

[Guest WCDES636]

Hmmmm. Abuse of the Medevac. In Westchester? Never happen. Years ago in Peekskill I was ordered by the Captain to wait for Statflight to transport my Pt. I transported by ground anyway. Not only did I get my Pt to WMC prior to the Aircraft landing in Peekskill. I met the aircraft on the Helipad to help them offload a second PT.

It is all Judgement. So we should use it. Every Scene is different.