Commentary: Thank You For Not Flying
Helicopter ambulances could be hazardous to your health.
- By Bryan E. Bledsoe M.D.
- Air & Space magazine, July 2006
(Page 2 of 3)
A 2002 Stanford University study evaluated 947 patients delivered consecutively to a California trauma center by medical helicopter and found that only 1.8 percent needed immediate surgery for life-threatening problems. The researchers concluded that only nine of the 947 patients possibly benefited from helicopter transport and that for five patients, helicopter transport was possibly harmful.
Last year, a group of university researchers, including myself, and state officials from Vermont and Wisconsin conducted a study of 37,350 trauma patients transported by helicopter from the accident scene to a hospital. We found that approximately two-thirds of the patients had injuries that, based on validated trauma criteria, are considered minor. (The abstract was published in the journal Prehospital Emergency Care, and the full article will soon be published in the Journal of Trauma.)
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.”