More research may be needed to demonstrate the scope of the problem, but questions about the utility of medical helicopters extend to the highest levels of the medical community. “There is simply not enough science [measuring the utility of medical helicopter transport],” says Richard H. Carmona, U.S. surgeon general and former medical director of the Arizona State Police medical helicopter program. “I am concerned that resources, such as medical helicopters, are used appropriately and cost-effectively for the benefit of the patient.” Carmona suggests that air ambulances be incorporated into the emergency medical system and be dispatched using a common communications system and be held to standards that decrease expenses.
Right now, the air ambulances have a lot of influence over when and where they fly. Overworked hospital physicians will gladly authorize helicopter transport—just to get a patient out of the hospital so another patient can fill the bed. Cost is often forgotten or not considered.
Likewise, at accident scenes, helicopters are easy to call for. Helicopter operations often provide volunteer fire departments and ambulance squads with free pizzas, coffee cups, key chains, and even medical equipment, and encourage the rescue workers to call for the helicopter before they arrive at the scene—long before they have a chance to even lay eyes on their patients. This adds to a system already out of control.
Many families are now being left with air ambulance bills ranging from $8,000 to, as in one case in Arizona, $40,000. Patients are being billed because Medicare administrators and private insurance carriers are more carefully scrutinizing compensation for helicopter transport, possibly because the number of flights paid for by Medicare alone was 58 percent higher in 2004 than the number paid for in 2001. Many of the for-profit helicopter operators hire collection agencies to aggressively pursue patients for payments of these unexpected bills.
Besides cost, safety is a consideration. The proliferation of medical helicopters has been accompanied by a marked increase in the number of accidents, prompting the NTSB to issue a safety advisory for medical helicopter operators last January. The bulletin recommended that ambulance operators improve qualifications of dispatchers, enhance preflight risk assessment, use night-vision imaging, and install terrain awareness and warning systems in all medical aircraft. The air medical industry is slowly beginning to initiate measures to enhance safety and clearly wants to dissociate from the idea that operators are the sole source and solution to the problem.
“Air medical providers are taking the NTSB recommendations seriously,” says Edward Eroe, president of the Association of Air Medical Services. “We want to partner with them to improve safety, as we all have to work together to make real improvement.”
But the increase in the number of medical helicopters has also resulted in a marked decrease in the number of qualified pilots, flight nurses, and paramedics available for hire. The rise in demand, accompanied by the retirement of Vietnam-era pilots from the medical helicopter ranks, has caused many medical helicopter operators to drop the minimum number of flight hours they require of pilot applicants. Furthermore, because flights equal revenue, some pilots are being pushed to fly in questionable conditions.
The tremendous increase in the medical helicopter accident rate prompted Johns Hopkins School of Public Health researchers to evaluate emergency medical service helicopter crashes from 1983 through April 2005. They found that being a member of a medical flight crew is now among the most dangerous occupations in the United States—six times more dangerous than standard occupations and twice as dangerous as mining and farming—similar in riskiness to the duties of combat pilots in wartime.
Here in the land of plenty, we have created a system that has taken a useful tool—the medical helicopter—and transformed it into the most dangerous and most expensive transport modality available.