^^^To build on Ben's comment, I am waiting for someone to blow the lid off air ambulance charges. Much of the time, the patient is unconscious or is otherwise in no position to refuse air transport. Combine this with the hospitals and/or the air ambulance companies love to launch their shiny toys because they don't make money on the ground. The patient gets a 20 minute flight to the hospital, which likely could have been done via ground transport, gets a bill for $ 40-50,000, the patient's insurance pays $ 10,000 of that and the patient gets a balance bill in the mid-five figures. Good luck paying it.
Yay, I get to tell my favorite air ambulance story again! Now I'll preface that in my area, we are actually pretty conservative with using air ambulance services. We've drilled into our medics that it has to save a minimum of 30 mins over ground transport (including the time for the air ambulance to respond to the scene, load the pt, etc). So in most cases, we usually won't even consider flying the pt unless we're 60+ minutes from a trauma center (the vast majority of the air ambulance flights here are serious trauma). And usually we'll only fly them if they meet the mandatory trauma system entry criteria.
Anyways, back to the story... So we get called to a horse stable that's about 60 minutes from the local trauma center. Right on the border of where we would usually consider flying a patient. They do a summer camp for kids with behavioral issues in partnership with one of the local care groups.... So teen girl falls off a horse. This is an indoor arena, with what looks like a foot of sawdust on the ground. I'm seriously surprised the horses can even walk on it it's so springy. So this girl starts claiming that she hit her head, that she blacked out, and she couldn't see.... 911 gets called, and the volunteer fire dept gets there before we do. And these guys go full on balls to the wall mode. They're all EMT's (since it's a volly dept, that's not uncommon) and so my partner is the only paramedic on the scene. However, in this county, the first on scene is person in charge, and it doesn't matter if they're an EMT Basic vs. a paramedic, it's first on scene is in charge. So these yokels get all excited and call for the whirly bird to fly this kid. Because of reported loss of consciousness. Staff are saying she immediately got up when she fell, didn't even really hit her head, but this girl is in full on status dramaticus. When everyone arrives, though, she's conscious, alert and oriented X4, GCS of 15. Totally normal. Not even a bump on her head. "BUT SHE LOST CONSCIOUSNESS!!!!!" is what the fire guys are screaming.... "WE HAVE TO FLY HER!!!!!"
No, you just want to look important and land the heli-whop-whop in a field.... But my partner, even though he's got the most training, can't dissuade this guy (he seriously had a "respect my authoritah!" thing going)... My partner eventually just "whatever, your patient, your responsibility".... So the helo is getting close, hotshot gives his patient report, and the nurse asks him to repeat the GCS.... "Fifteen" hotshot replies.... "FIFTEEN?
" the nurse explodes. "Whatever. we'll see you on the ground in 3 minutes". (For those not in the medical field, a GCS of 15 means no neurological deficits at all. We don't fly trauma patients with a GCS of 15 unless they're missing a limb or have a penetrating trauma to the torso or similar....)
Hotshot is now starting to realize he screwed up. Nurse climbs out of the helicopter, and starts getting wound up to blast my partner... Since he's the only one with a Paramedic patch on his shoulder.... He just points at the firefighter who is now trying to blend in with the grass and hide behind the engine... She marches over there, and even over the helicopter idling a couple hundred feet away, I can hear her yelling at him....
But the most disturbing part is that even knowing this patient most definitely didn't need a helicopter ride to the hospital, did they self-cancel and return to base, or just not take her once they'd landed? Nope! Loaded her up and gave her a very expensive taxi ride to the hospital.