1. #1
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    Default Air medical: Worth it for you?

    There's an article on the front page right now <http://cms.firehouse.com/content/art...Id=46&id=39911> debating the value of air transport. I get a little perturbed at the blanket statements made in a lot of these reports (from the mainstream media), because so many of them suggest that air medical doesn't help and can in fact be worse than ground transport.

    I realize everyone has different circumstances, but nothing could be further from the truth in our situation. We are in a rural area with a level 3 trauma center. Flight time is roughly 20 minutes from notification until the bird can be at an LZ. We can often have a patient to the Level I in WV faster than we could have him/her to the local ER via ambulance.

    One good example of how well this works for us was an ATV accident we had a couple years ago. Patient had a midshaft femur fracture, possibly internal injuries, and was located half a mile into the woods. We set up an LZ in a large pasture at the edge of the woods, and by the time we had him packaged, IV'ed, and moving, the chopper had arrived. We had him out of the woods in ten more minutes and he arrived at the hospital in twenty more. Had we taken him by ground from that remote location, he would have easily been 30 minutes to the hospital; instead, he was 20 minutes getting to the trauma center.

    My questions (and I do have some) are these: Is this report reasonable? Does this sort of media coverage highlight the majority or minority of situations? Is it creating an excuse for insurance carriers to stop paying for air evac, thus endangering the system for those of us who need it? Are unnecessary flights jeopardizing the system?

    We need our helicopters!
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    Originally posted by EastKyFF
    We need our helicopters!
    From personal experience, AirEvac is a very viable and very valuable tool. We are of a similar situation to what EastKy describes, add to that the traffic congestion during an event that would require airevac would make ground tpt almost impossible sometimes.
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    The hospital in my community is 15 miles away from UMass Medical Center and a 20 minute drive in normal circumstances from there via I-290. It's an 8 minute flight.

    We do a lot of helo standbys at the hospital ( we send an engine to cover the helipad and we also provide scene coverage for LZ's other than the hospital's helipad, and guys are constantly bitching that sending a patient to UMass via LifeFlight is a waste of time and money.

    The question that I ask them is..

    Do you have four years of pre Med, 4 years of medical school, one year of internship and three years of residency under your belt?

    Do you have the title "MD" after your name?

    Do you know the reasons why the ER docs want to fly the patient as opposed to ground transport?

    Do you even know what hospital they are going to be flying to?

    No? Then shut the (expletive deleted) up!

    Life Flight is unique in the fact that UMass Medcical Center is a teaching hospital with it's own medical school and that they fly with a flight nurse and a doctor. The Docs are residents and are "on call" to fly missions that pertain to their specialty (cardiac, trauma, pediatrics, etc)
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    I would love to be able to add to the discussion, but it ain't an option for us and our nearest trauma center is 30 miles away (an hour by ground during rush hour).

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    edited by user
    Last edited by superchef; 08-18-2007 at 04:50 PM.

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    EastKyFF,

    You can help the critics understand. Invite them out for a ride- get way out on a 2 lane road in Letcher County, about 50 miles from nowhere, behind an overloaded coal truck. (not terribly unusual)

    Now ask if they would need a helicopter if they were having the big MI, or if a 3 hour ride to Lexington would be OK.

    I've been on the receiving end of the ride for a lot of these folks, and it's the only reason they made it.

    Doc

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    In my area, it's a matter of when the decision to fly is made. If it's early enough on the call, it makes sense, otherwise, we go by road. Trauma center for me is a 13 minute ride by ambulance, barring any unforseen circumstances. Air time is about 3 minutes, still better but the bird better be sitting on the ground, running and ready to go when we get the patient to it. With such a short travel time, we will not wait for the helo to get there. I would never say they are without value though.
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    Default We have some problem

    In my area we have had problems with the med flight being called and Pt's walking out of the truama center 20 min later. Doctors around here like the service but the local medic's abuse it because some of them are working for the air service too.
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    Default Re: We have some problem

    Originally posted by Ltmdepas3280
    In my area we have had problems with the med flight being called and Pt's walking out of the truama center 20 min later. Doctors around here like the service but the local medic's abuse it because some of them are working for the air service too.
    That IS the problem. We have two level 2 and one level 1 trauma center in our area, with six choppers. I happen to have three flight medics on my FD shift. I have never seen them fly a patient that didnt need it. They realise better than most the cost per flight, let alone the danger of it. Im sure we all agree its not the safest way to transport a patient.

    And you wouldnt belive the stories they tell me about some of the patients they are called for. Broken ankles, patinets with no complaints but the MVC they were in "looked bad" etc. Things that didnt need a trauma center, let alone a chopper.

    At my part time ambulance job, I have been on calls where FD has requested a chopper and I just shake my had. Its pretty bad when an EMT ambulane driver can look at a patient and think to themselves "your flying THAT".

    It a fantastic tool to have, but its the field medics (EMS & FD) that are going to screw it up and cause some of these services to close. These services cost the hospitals BIG money, and flying broken ankles isnt going to pay the bills.

    Its on all of us in the field to use SOUND judgement on when and when not to call for the chopper.
    Last edited by Dave1983; 03-04-2005 at 05:23 PM.
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    In our area, it's up to EMS command whether to call for the helicopter or not, it's all on situations, were in the middle of two Level II trauma centers that are both about 20 minutes away, we usually call for major traumas, accidents with extended extrication times or special circumstances (burns,spinal cord injuries have to go to University Hospital in Syracuse about an hour away by ground).
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    In the Metro Toledo area we have 8 hospitals, all of which are in Lucas County. There are a few other hospitals in the adjoining counties, also. Of the ones in Lucas County, there are 3 Level III Trauma Centers and 3 Level I Trauma Centers. There are also 2 Helicopter Services in this area, which are ran by 2 competing Parent Companies of some of the hospitals. Each Company has 3 hospitals in the county....... Between the 2 Helicopter services, there are 7 or 8 helicopters........

    The majority of the flight transports in this area (probably 60-70%) are hospital to hospital transfers (usually coming up here from 2-3 counties away). There are a few FDs/EMS agencies that may "abuse" the system, but I think the majority of PTs that get flown need it. (PFD109, you can probably add to this). Probably the closest thing that comes to "abuse" is an island in Lake Erie (Put-in-Bay), flies quite a few pts in the summer time, since there is no hospital on the island and a flight is quicker than waiting for one of the ferries......
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    Though it causes a lot of consternation, I believe what we have here is a good setup. There are several air ambulances but our first-due is very conservative about when they will fly. This causes a lot of griping by the medics. Oh well. They (CalSTAR) have not had a crash that I know of.

    The second reason is the medical director is very picky about who gets to fly. Every helicopter transport PCR gets looked at by him. If the patient doesn't make pysiologic criteria then the medic has to call the hospital to get permission from the doc. We run modified base so not much hospital calling gets done ordinarily. So anyway what happens is one of three things is true for every helicopter call: it met obvious physiologic criteria, the doctor at the time said to fly 'em, or the medic gets called on the carpet

    As the other poster stated we can usually get them to the trauma center faster than ground transport to the hospital. Usually the helicopter sets down at the LZ before the ambulance gets there so no time is wasted, and ours is a slow helicopter anyway.

    This sort of "study" happens all the time. It's not the data it's the people interpreting it (and applying too many generalizations).

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    We have a level III trauma center in town. Around 30 minutes away sit a number of level I centers, so whenever we get something good they go there. Our two aerial medevacs are great, fly often, and will come any time we call em. A lot of the calls are made by senior firefighters or medics. I've seen some medics abuse it or take overly cautious choices to fly, but oh well..
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    Thumbs up Bottom line? Results...

    I work at St. Joseph Mercy Hospital in Ann Arbor, MI. I have seen first hand plenty of patients brought in directly from accident scenes that simply would not have lived without Med-Flight. That makes all the other "problems" worth it.

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    This thread hits close to home for me, having lost a good friend and founding member of our VFD in a Air Evac crash this year. Air evac flights are probably underutilized in our area. Our local ambulance service seems to try and not use air evac for some strange reason. We had a pt ejected from a MVC (about 50 feet!) with a head injury and the pt was combative. But they transported 25 miles to the hospital. Rest assured that if we get on scene before they do and we need air, we'll call them in a heartbeat! The local air evac service does a lot of hospital transfers, but for good reasons. Two of the hospital they transfer to are 2.5 hours away and 4.5 hours away! Yes, it's dangerous, but how many lives are saved each year by those brave souls who land in a small LZ in the middle of the night!
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    The problem is that, at least in my area, if they only flew the bird when it was truly needed, it would be a real financial problem to keep it afloat. Up until 5 years ago, there were 2 choppers flying but there wasn't nearly the volume here to keep them both operating, so the 2 hospitals condilidated it down to one operation with one bird. Even now they can go days without being called.
    We have been having a problem of late where the flight crew has been working on the patient for 15-20 minutes on the ground even before they begin to load. Because of that, the local EMS service has decided that ground transport is just as fast and the care is just as good with 2 paramedics (usually in trauma cases they borrow opne of opur drivers to drive the bus)and we only use the chopper in severe trauma situations.

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    I don't know if this is an abuse situation...but we do call for air evac on most accidents involving multiple victims. What normally happens is the victim who is in the worst shape gets put on the helo. The rest get taken by squad. One of the reasons we call for a helo is thats one less person to transport by squad...and squads sometimes take longer to get onscene than a helo...Also it frees up a few people to continue on scene instead of piloting a bus to the hospital...I mean there aren't any "pure paramedics" in the area, and I would rather an air med unit deal with patients if we can because they can't help us on scene with "fire rescue" type operations. Now if its three people that were seat belted and hit something in a parking lot thats different...but if MOI is severe then we automatically call the air med. If we get onscene and realise that we have only minor injuries on our hands we can always cancel an air med in flight anyways

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    Well coming from a part of the country at didn't use Evac's I once wondered if they are needed. But now as a vollie in south east central Ky / bordering Eastern KY. We need and love evac. The closets hospital that can handle major cases are all in lexington. It will be at least a hour to get to them. But only 11 mins via air. If we call for a medflight we can have two companies UK and LifeNet. Both the lifenets can land and load a patient in my fire area within 6-10 mins. I know that EastKy is dealing with and he is in a far more rural area then me.
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    We used to use LifeNet out of Tallahassee, FL a lot for patient transport to Tallahassee Memorial Hospital. They could usually be to us in 10-15 minutes, many times faster than that. TMH takes anywhere from 30 to 45 minutes or more to get to even if you are running hot.

    We now have a helicopter, AirMedic 2, stationed here in the county. If they are already on standby, they can usually be to us in 5-10. On scene time is around 5 minutes, and they can get to TMH in 8 minutes. That's anywhere from 12 to 30 (or sometimes even more) minutes they can save.

    We also have pre-designated landing zones set up, so that helps out a lot when trying to find a place to land them. I can't find a picture of the helo right now.
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    Originally posted by LaFireEducator
    The problem is that, at least in my area, if they only flew the bird when it was truly needed, it would be a real financial problem to keep it afloat. Up until 5 years ago, there were 2 choppers flying but there wasn't nearly the volume here to keep them both operating, so the 2 hospitals condilidated it down to one operation with one bird. Even now they can go days without being called.
    We have been having a problem of late where the flight crew has been working on the patient for 15-20 minutes on the ground even before they begin to load. Because of that, the local EMS service has decided that ground transport is just as fast and the care is just as good with 2 paramedics (usually in trauma cases they borrow opne of opur drivers to drive the bus)and we only use the chopper in severe trauma situations.
    Never call a helicopter a "chopper". It really irks the pilot, who prefers the term "driver" to pilot.

    I have flown with LifeFlight's CAST program (worth 8 hours ceu towards emt recertification), their helo drivers are fantastic!
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    I know that some services fly out patients that from what I've seen don't need it. Saw a patient with a fractured ankle get airlifted. Know of services that fly patients only due to the fact that around here one of the criteria for airlift is if the patient going by ground takes the services only unit out of service for the ground transport. Honestly I think the reasons or criteria for calling a helicopter need to be rewritten due to the fact that more advanced procedures are becoming more basic.

    I've seen both ends of the spectrum from rural ems to metroplex ems. But like EastKyFF's circumstance I don't have a problem. If it's a 40 minutes ground transport versus a 20 minute flight and the patient is critical then by all means call the bird. Basically I just think there needs to be good justification for airlifting a patient to the hospital. Most of the time it is justified.

    I hope the insurance companies don't go by the study and cut their rates.
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    Arrow About 5-6 times a year depending ......

    '77 gave the demographics for our area. In our department, we use the bird based on MOI and pt. condition. We have a great relationship with one of the aeromedical services here.
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    Thumbs up Totally Different Approach.......................

    In Maryland, there are a few options in Air Transport, but only one, MedStar, is not a public safety based operation. Most Air Transport cases are handled by the Maryland State Police, with 8 Helo bases around the state. All personnel on the Helicopters are State Troopers, with the flight Medics trained to EMT-P level with additional specialties that relate to the job. Do we use them? Yes. Is the service adequate? Yes. Would we make a change? NO. We're damn proud of the system that we have here. The United States Park Police operate Helicopters also, based in Washington DC, and in the area around DC, they are the backup for the MSP units. They do an outstanding job as well. One point about the fact that these are Law Enforcement units. Medivac calls take precedence over everything else. Some years ago, we needed one, and when it arrived, they dumped the Governor of the State of Maryland out at the LZ, and took off with the patient. Seems that they were taking the Gov. and one of his staff to a meeting. The Gov and his secretary rode back to the station and had a cup of coffee while waiting for a Trooper to arrive to take them on, by Car.
    Last edited by hwoods; 03-05-2005 at 11:30 PM.
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    i wonder if they spread around their reasearch by asking people in rural areas where its hours inbetween hospitals or just kept it to the major cities where the hospitals are plenty.

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    Originally posted by WaffleHut
    i wonder if they spread around their reasearch by asking people in rural areas where its hours inbetween hospitals or just kept it to the major cities where the hospitals are plenty.
    I would be interested in that answer as well.

    Out here in the mountains we don't have an air ambulance service, but we do commonly utilize the private helicopters from our on-resort heli-skiing/heli-hiking operation. An injury on our hill, or in the immediate backcountry can easily take an hour or more just to get down to the village where a ground ambulance can pick them up. Technical rescues can take hours if there is no direct access route. Then it is a 30+ minute drive to the local small-town hospital (not a trauma center).

    Once at the local hospital, the PT is usually flown to Foothills Trauma Center in Calgary Alberta via STARS Air Ambulance, saving at least 2 hours of transport time.

    As for the cost issue, I have never had a PT or the PT's family dispute a helicopter bill. Would you if you knew you or your family member was seriously ill or injured.

    I don't think you can possibly argue against the benefits of either type of helicopter use in our environment.
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