Air ambulance rides come with high cost

[helicopper 1,050]

Simple math tells you with a dispatch to in ground ambulance time of say 25 minutes with a pin job, and a 15 minute drive to the hospital, 40 minutes is well within the golden hour. Now look at it with calling a bird. Give it 10 minutes to arrive on scene, another 2 to determine you want the bird, and you get an ETA of 25 minutes for arrival. Now you're already 12 mintues behind the transport clock. Extricate the Pt in the same amount of time, and load him into the ambulance to wait for the bird. Bird arrives (actually ON TIME!!!!! Kudos!) at the 37 minute mark, add 3 minutes to load the Pt up, you're now at 40 minutes. Give him a 10 minute flight time and now you're at 50 minutes. Good job, you've cost the patient tens of thousands in medical bills, and delayed them by 10 minutes (and lets remember we ourselves are HUGE proponents of SECONDS COUNT!!!!!!!) to getting their ruptured innards repaired because you thought a air ambulance ride was in their best interest. You pull the latter of the two scenarios on me if I was in an accident, and I don't care what the outcome is, you're getting sued by me to have your license revoked.

Inappropriate services would be an air ambulance ride in 80% of the areas of this county. Period.

Your simple math is right on the mark. Once a patient is transport ready there is no reason to wait for a helicopter if you can begin ground transport. If the helicopter is there, running, and the crew is ready to take the patient and transport, fine, but how often does that happen? Response times are often estimated to be lower than actual, scene time is far longer than 3 minutes, and the flight time/off-loading time really nets you no savings.

I am a huge proponent of using air ambulances wisely but I don't think if you're within 20-30 minutes driving time of a trauma center you have a compelling case for flying.

While some lawyers may argue that this doesn't give rise to negligence, others will argue (and charge handsomely for the privilege to do so) that it does and who's caught in the middle? EMS and the PATIENT! We should be advocates for the patient and the very real financial and safety implications of air transport needs to be thought about. If the patient doesn't present with findings that warrant a flight, they shouldn't get a flight. Unfortunately, many of the posters here are describing situations where this was the case.

[PEMO3 523]

I agree total that you need to be well over the 30 min drive time mark or have extenuating circumstances to call for a bird. Unfortunately, with shows like the now defunct "Trauma" glorifying the fly them out concept and presenting a bird on patrol, dropping in at a moments notice and even in some case dispatched in place of a bus to a call it makes some think that by air is faster. EMSJunkie712 is on the money with his numbers and puts together the best visual argument for the 'driving is faster" statement. It is unfortunate that some still put the "bird on standby" before even rolling up on the scene based on dispatch data.

[SRS131EMTFF 471]

I completely understand what you are saying. Its not that I dont agree its a problem, I just I dont believe its negligence.

Luckily our firehouse lawyers are actually lawyers, including several specializing in medical malpractice, so I will get opinions from them and report back.

Having spoken to a malpractice lawyer I was given three reasons why it is not negligence:

1) As long as you can justify why you thought it was needed it is not negligence

2) If you are acting in the best interest of the patient it is not negligence

3) Waiting for the air ambulance and the higher trained provider is not an incorrect decision to make and there for not negligence.

Waiting for the air ambulance even with a critical patient alone does not constitute the legal definition of negligence or malpractice. One actually has to do something wrong and violate the standard of care to be negligent.

[INIT915 1,119]

I think both sides have a case. The "negligence" in this case is subjective. You could probably articulate some wait, but at some point, the wait could probably be deemed excessive, and therefore negectful.

[ny10570 745]

bvfd, either you need better lawyers or there was something lost in the discussion. Ignorance and good intentions are not valid legal defense. They'll save you from the dreaded and expensive gross negligence, but if you're wrong and the court believes that most providers of similar training and similar experience would have gone a different route then you are at fault. Number 3 is shaky too, because what service are waiting for from the helicopter? Waiting on scene at a trauma for a dermatologist would absolutely get you in hot water and waiting on scene for a trauma surgeon should get you in trouble. If the airway is managed and the bird is not substantially faster than driving, why are you waiting for it?

[STAT213 332]

All good discussion about the pros and cons of sir medical transport. I am a big proponent of getting the patient to the RIGHT hospital, regardless of mode. Having flown the friendly skies above Westchester for a number of years, I can tell you there were some rediculous calls I shouldve told the ground crews to drive in themselves, or at the very least called them to talk about the math mentioned above.

I'm not gonna comment about the use of AMT in general as that issue is one that needs to be sorted out nationally. I do think there are far too many helicopters in certain parts of the country and overuse has lead to the current mess the air medical industry is in.

One thing that's stood out on this discussion is a few people railing on calling helicopters or placing them on standyby based on dispatch info or early info. As someone who flew for years, I can tell you that early activation makes a HUGE difference. It gets the a/c to you that much sooner. It also helps prevent the desire to transport to a small hospital not equipped to handle trauma.

The research on getting patients to Level One Centers is clear. They do WAY better when transported directly to a Level One. So, calling the a/c early to ANY call where you need the them will only help reduce times.

[SRS131EMTFF 471]

bvfd, either you need better lawyers or there was something lost in the discussion. Ignorance and good intentions are not valid legal defense. They'll save you from the dreaded and expensive gross negligence, but if you're wrong and the court believes that most providers of similar training and similar experience would have gone a different route then you are at fault. Number 3 is shaky too, because what service are waiting for from the helicopter? Waiting on scene at a trauma for a dermatologist would absolutely get you in hot water and waiting on scene for a trauma surgeon should get you in trouble. If the airway is managed and the bird is not substantially faster than driving, why are you waiting for it?

The opinion I posted above was given to me by three different malpractice attorneys all interview separately and independently.

I presented them with the same situation. 45 YAO Male Patient. In care of ALS. Traumatic injuries-Unstable. Bird is on its way with 5 minutes until the bird lands but the local trauma center is 15 minutes away.

I asked is it considered negligence or malpractice to wait for the bird despite the unstable patient and the trauma center 15 minutes away?

The same answer I got from them was that it does not legally constitute malpractice nor negligence. Is it a good decision to make? No it is not, but it is not the wrong decision to make and the reasons why it is not are what I posted above. I understand you may disagree or your "firehouse" "lawyer" may have told you a different answer but the fact is 3 different lawyers with over 60 years of combined experience, including years arguing as prosecutors and before the NYS Supreme Court and the Federal Court said otherwise.

Edited November 27, 2010 by bvfdjc316

[INIT915 1,119]

The opinion I posted above was given to me by three different malpractice attorneys all interview separately and independently.

I presented them with the same situation. 45 YAO Male Patient. In care of ALS. Traumatic injuries-Unstable. Bird is on its way with 5 minutes until the bird lands but the local trauma center is 15 minutes away.

I asked is it considered negligence or malpractice to wait for the bird despite the unstable patient and the trauma center 15 minutes away?

The unequivocal answer I was given is that it does not legally constitute malpractice nor negligence. Is it a good decision to make? No it is not, but it is not the wrong decision to make and the reasons why it is not are what I posted above. I understand you may disagree or your "firehouse" "lawyer" may have told you a different answer but the fact is 3 different lawyers with over 60 years of combined experience, including years arguing as prosecutors and before the NYS Supreme Court and the Federal Court said otherwise.

I think two things come to mind:

1) In your example, waiting 5 minutes for Medevac is slightly different that the "longer" waits that we're touched upon earlier.

2) Anytime any lawyer says anything is "unequivocal", be suspicious. The law, by its very nature is equivocal. There is little if anything in the law that is unequivocal. If their opinion was that there was no criminal negligence, that has a little more foundation then if they inferred there was no civil negligence. Anyone who spends anytime in Civil Court knows it makes little difference if the facts or law are on your side or not. It quite literally comes down to who tells their story better.

[SRS131EMTFF 471]

What I meant by unequivocal was I got essentially the same answer from each one. I am sorry I was not more clear in my above post. My original post now reflects what I was told.

Edited November 27, 2010 by bvfdjc316

[Goose 188]

http://www.hvremsco....-%20w-cover.pdf

From the Hudson Valley - Westchester Helicopter Committee, spells it all out pretty well i think. Thanks for the edit so that it was added as a pdf attachment helicopter.

Something i forgot to mention when i wrote this earlier relates to who can request the aeromedical resource. I remember discussing this when i worked in areas where having a helicopter being put on standby and launched before the first EMS provider on scene was common.

The committee states pretty clearly that an ALS provider make the judgement call, if he/she is unavailable or delayed BLS can make the call and if no EMS is available Fire or PD can make the call.

That seems pretty straightforward, but lets say the setting is a fly car ALS system with a timely BLS and fire response. Job comes in for an MVA, everyone responds. Fire chief beats everyone (they tend to be the closest and most timely in their own response vehicle) to the scene and calls for AMS. While there is no EMS provider on scene, they are on their way, only a few minutes out. Right move or wrong move?

Regional Air Medical Service Guidelines.pdf

Edited November 28, 2010 by Goose
Repaired link to document and added it as an attachment.

[velcroMedic1987 330]

1728hrs-XXFD Car-2 on the scene, advising one person on the ground.

1729hrs-Car-2 requesting Medevac on stand-by.

1730hrs-Car-1 on the scene, assuming command.

1731hrs-EXXX responding. XXXX 911 advising that LifeNet is standing-by with an (8) minute ETA.

1734hrs-EXXX on location.

1735hrs-XXX Command requesting a launch of the medevac, Car-1 will be the ground contact on 46.XXX. XXXX 911 advising (8) minute ETA for the Medevac from stand-by.

1736hrs-Command requesting an ETA on the Medevac for EMS, he's having trouble reaching them.

1750hrs-Medevac with a 0-2 minute ETA.

1754hrs-Medevac is on the ground.

Here's another problem with the medevacs in our area. Put on stand-by at 1729. Give an EIGHT minute ETA at 1731. Requested at 1735. On-Scene at 1754. I'm no genius but that seems like 19 minutes to me. Then they give a TWO minute ETA but don't show up for FOUR. What BS.

So because of a BS ETA from the medevac operator the ground crew had to sit around for almost 20 minutes waiting when they could have been on the road.

[50-65 205]

Here's another problem with the medevacs in our area. Put on stand-by at 1729. Give an EIGHT minute ETA at 1731. Requested at 1735. On-Scene at 1754. I'm no genius but that seems like 19 minutes to me. Then they give a TWO minute ETA but don't show up for FOUR. What BS.

So because of a BS ETA from the medevac operator the ground crew had to sit around for almost 20 minutes waiting when they could have been on the road.

yep. and if is the call that I'm thnking of, the ambulance was at the LZ with the patient a full 4 minutes before the ETA of the helicopter. (Remember, the "E" is for estimated). and I believe the ETA is to the scene, not necessarily on the ground. Then, based on the direction the helicopter was flying several minutes later, I could guess which hospital they were going to. After I timed it while listening to the radio traffic, my guess is that the ground ambulance would have arrived at the same hospital at nearly the same time as the helicopter.

[ny10570 745]

The opinion I posted above was given to me by three different malpractice attorneys all interview separately and independently.

I presented them with the same situation. 45 YAO Male Patient. In care of ALS. Traumatic injuries-Unstable. Bird is on its way with 5 minutes until the bird lands but the local trauma center is 15 minutes away.

I asked is it considered negligence or malpractice to wait for the bird despite the unstable patient and the trauma center 15 minutes away?

The same answer I got from them was that it does not legally constitute malpractice nor negligence. Is it a good decision to make? No it is not, but it is not the wrong decision to make and the reasons why it is not are what I posted above. I understand you may disagree or your "firehouse" "lawyer" may have told you a different answer but the fact is 3 different lawyers with over 60 years of combined experience, including years arguing as prosecutors and before the NYS Supreme Court and the Federal Court said otherwise.

Your problem is the details of your question. The clock doesn't stop when the patient hits the helicopter. It doesn't matter how long the patient sits at the LZ if the bird gets you to the ER faster. If the flight will take longer than the drive because of the wait at the LZ then you are potentially doing harm to your patient.

[SRS131EMTFF 471]

Here is a question that I am not sure anyone can answer even helicopter. In the 50 years since Vietnam that medical aviation has come into play exactly how many civilian helicopter evacuations of patients have occurred? Additionally how many military patient evacuations. My round guess is over tens of thousands if not hundreds of thousands during Vietnam, Panama, Iraq I and II, and Afghanistan. What is the accident rate of military medi-vac helicopters? My guess is significantly lower than civilian. If that is the case, what is the military doing better that the civilian world is not and what can be adapted from the military to civilian use.

[ny10570 745]

Training and equipment. There's a reason military pilots are so coveted n the private sector, few other places offer nearly as much flight time. Military aviation has been using NVG since its inception while many commercial operations still don't use it. Military aircraft tend to be more robust as well. They're not exactly concerned with operational expenses the way commercial providers have to be.