Monday, February 28, 2005

Send The Whirlybird II....
From The New York Times:Crashes Start Debate on Safety of Sky Ambulances:
On a mild afternoon last week, emergency workers raced up to Jana Austin's rural Arkansas home to ask if a medical helicopter could land on her property to transport a victim of a car crash to a nearby hospital. Ms. Austin, a nursing student, said she readily agreed. But moments after the helicopter took off, she and her 4-year-old daughter stood stunned, watching as the helicopter began to spin, slowly at first, then faster, until it twirled out of control into a nearby pasture. The patient died, and the three crew members were seriously hurt.

The accident, whose cause is under investigation, was hardly isolated. In January, a medical helicopter plunged into the Potomac River in Washington, killing the pilot and a paramedic. In less than two months this year, four people have died in four accidents. Last year was a particularly deadly one for flight crews and patients, with 18 people killed in 11 accidents, the highest number of deaths in a year in more than a decade, according to federal regulators and an industry group.
As expansion baseball has diluted the talent pool in pitching, the same may be said of air ambulance pilots, and their helicopters:
The spike is putting a spotlight on a little-regulated and fast-growing sector of health care: the medical helicopter industry. There are an estimated 700 medical helicopters operating nationally, about twice the number flying a decade ago.....
......Federal regulators and some doctors worry that the pool of skilled helicopter pilots has become drained and that some of those flying are making poor decisions. In addition, some companies are flying older helicopters that lack the instruments needed to help pilots navigate safely. Of the 27 fatal medical helicopter accidents that occurred between 1998 and 2004, 21 were at night and often in bad weather, according to federal statistics.
The air ambulance industry is certainly more entrepreneurial:
Medical helicopters were once nearly all affiliated with hospitals. But more generous federal reimbursements and changes in payment methods have attracted more operators, including publicly traded corporations and smaller concerns that in some cases set up outposts and market their services to rural emergency units and even homeowners.......
....Another significant area of industry growth involves companies that are not connected to hospitals but instead set up helicopter bases in rural areas and then market their services to local hospitals, emergency officials and, at times, homeowners.

For example, Air Evac Lifeteam, which started 20 years ago with a single base in West Plains, Mo., now has 43 sites in 10 central states. For $50 a household, homeowners receive a company membership guaranteeing that Air Evac Lifeteam will not seek additional payment from them beyond what an insurer will pay. Over 150,000 households are signed up, Air Evac executives said.
There is a vigorous debate as to the utility of helicopter ambulances. A Dr. Bledsoe is quoted in the article, the same Dr. Bledsoe who was lead author of this Journal of Trauma paper from June 2004:Medical Helicopter Accidents in the United States: A 10-Year Review. :
Results: There were 84 medical helicopter accidents involving 260 persons (passengers, patients, crew, and pilots) during the 10-year study period. Of these, there were 72 fatalities and 64 injuries. The incidence of fatalities was 0.86 fatalities per accident. The incidence of nonfatal injuries was 0.76 per accident. Fifty-two percent of all reported accidents occurred during the last 3 years of the study period (2000-2002).

Conclusion: There was a steady and marked increase in the number of medical helicopter accidents in the United States during the 10-year period (1993-2002). These findings are worrisome in light of recent research that has indicated use of medical helicopters may be excessive and nonbeneficial for most patients.(emphasis mine)
Further papers from The Journal of Trauma may be found here and here.
Now as the article points out, the increase in collisions may be related to the absolute increase of helicopters in the air and the "incidence per passenger mile" may be stable. The industry will begin to monitor that in the spring. Certainly air ambulances have their roles in rural areas with bad roads. Sometimes patients may require care that only a air-ambulance crew can provide. Your county EMS may only have one or two ambulances and can't afford to lose capacity transporting patients to a faraway referral center. Helicopters are sexy and cool as well.
(As an aside it was always a coup when you could discharge a flown-in trauma from the ED. Even funnier when the patient would ask when the helicopter would arrive to take them back home.)
In my opinion the crash described above was for a trip of dubious value:
Local emergency officials said that the Arkansas car-crash victim, Robert Arneson, 71 of Harlingen, Tex., had a gash on his forehead but was stable and alert when taken by ambulance to a field for helicopter transfer.

It was about 20 air miles, or a seven-minute flight, from the crash site, a trip that would have taken about 45 minutes by ground. But because emergency workers had to locate a landing site, nearly an hour elapsed, officials said, after the first emergency call and before the helicopter took off.
So this patient could have been at the hospital, alive, with time to spare before the helicopter even took off.
Weblog Commenting and Trackback by HaloScan.com

This page is powered by Blogger. Isn't yours?