IN A SMALL COMMUNITY hospital in rural Indiana, a 63-year-old man is suffering from heart problems. The treating physician determines that the patient’s condition is serious and makes arrangements to move the patient to a larger hospital with more resources and specialists. A medical helicopter is called to make the transfer. No one questions the increased cost of using the helicopter—or the extra risk inherent in flying.
There is nothing remarkable about this scenario. Every day, patients in communities across the United States are transported by medical helicopter. But the 63-year-old patient on this flight didn’t arrive at the larger hospital; the helicopter transporting him crashed en route. With the others on board too seriously injured to help him, he strangled to death on a restraining strap. The injured crew and pilot were transported by another helicopter to a trauma center. The National Transportation Safety Board (NTSB) ruled the cause of the accident pilot error; before the flight, the altimeter was known to be malfunctioning.
This disaster is one of 35 medical helicopter accidents that occurred in the United States in 2004 and 2005. Since January 2005, nine crashes resulted in 23 fatalities, a rash of medical helicopter mishaps not seen since the 1980s.
It is widely assumed that medical helicopters provide a significant advantage for patients and save lives. However, recent studies have begun to demonstrate that few patients actually benefit from medical helicopter transport, even during most emergencies. Helicopter transport is appropriate for patients who have conditions that require a time-sensitive intervention, such as life-saving surgery or cardiac angioplasty. These conditions are rare.
Medical helicopters were first used for civilian health care in the 1970s. Initial scientific studies in the 1970s and 1980s indicated that patients transported by helicopter had improved outcomes over those transported by ground. Therefore, many hospitals purchased helicopters and began offering helicopter transport. Today, there are nearly 800 medical helicopters in the United States. In metropolitan Phoenix, Arizona, alone there are more medical helicopters than can be found in all of Canada.
One of the reasons for this proliferation is a change in health care regulations. In the late 1990s, the air ambulance industry was successful in pushing federal regulators to increase Medicare payments for air transports. With an improved reimbursement scheme, an opportunity suddenly opened up for commercial operators to enter the arena.
Many helicopter transport companies opted for less expensive, pre-owned, single-engine aircraft—scores of which had already put in decades of work ferrying oil rig workers to platforms in the Gulf of Mexico. Many of the commercial operators also kept salaries for pilots and medical personnel relatively low in order to field additional aircraft. Medical helicopters became commonplace.
Recently, researchers have again studied the helicopter transport of ill or injured patients and have drawn considerably different conclusions from those of the researchers working two decades earlier. There is increasing evidence that only a fraction of the patients transported by helicopter derive any significant benefit over patients transported on the ground, a change likely due to improved capabilities of land ambulances.
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.)