You will need another ambulance when you get the air ambulance bill

[MillCreek]

http://www.nytimes.com/2015/05/06/business/rescued-by-an-air-ambulance-but-stunned-at-the-sky-high-bill.html?partner=rss&emc=rss

Based on my experience in healthcare and the EMS system, I am of the opinion that many, if not most, of the air ambulance missions are clinically unnecessary, have no effect on patient outcome and are done primarily for financial reasons.  There are situations such as distance from the hospital or truly urgent clinical scenarios that may favor air transport.  There is only one air ambulance system in my region, but the article called it true insofar as in other areas, there are too many helicopters chasing too few patients, and the insurance payments are being cut or eliminated.  Not to mention that aeromedical transport is more dangerous to patients and staff than ground transport.

[RevDisk]

Unless it's wilderness recovery, air ambulances are unnecessary. Fatalities from crashes or incidents actually outweigh the few lives that'd be saved by solely by helo rather than ground. Wilderness recovery does make sense, because it could be a 6+ hour journey back to the nearest road. With any terrain that is accessible by regular ambulance, it's the better and safer choice.

Source: I supported helicopter medical ambulances until we sold off that division. 

[KD5NRH]

Based on my experience in healthcare and the EMS system, I am of the opinion that many, if not most, of the air ambulance missions are clinically unnecessary, have no effect on patient outcome and are done primarily for financial reasons.

We see a lot of that here; places where a pt is picked up less than 15 minutes' drive (on good paved roads) from the nearest ER by a helicopter that took 30 minutes to get there, or transported from the local ER to one that's under 90 minutes' drive (for a regular car waiting the full duration of every light, etc.) away.

I can sort of see it when they're going to Children's or another Dallas hospital, since even on I-30, traffic through Fort Worth and Arlington can end up at a dead stop from time to time, but even in those cases it seems like it would be more practical to take them by road as far as Fort Worth, then if traffic (and patient) conditions warrant at that time, have a bird waiting at JPS or Harris FW to ferry them over the bad spots.  (AFAIK, one already sits at Harris Granbury, so it seems timing would be better served by using the 30 minute drive there to prep the helicopter rather than waiting for it to prep and fly here then turn back to DFW area.)

[mgdavis]

Airlift NW has lost at least one, and maybe two, in the last few years.

From the local hospital that I used to work at to Harborview in Seattle is either an hour by ambulance or seven minutes via helicopter. I think that most of the patients that were airlifted out of our ER were trauma cases, where the difference in time in transport probably did make a difference.

[MillCreek]

For many health systems in urban environments, having a helicopter is an expensive shiny status symbol that helps you stand out from the competition.  Much the same reasoning used by local TV stations to buy a helicopter.

[MillCreek]

Airlift NW has lost at least one, and maybe two, in the last few years.

From the local hospital that I used to work at to Harborview in Seattle is either an hour by ambulance or seven minutes via helicopter. I think that most of the patients that were airlifted out of our ER were trauma cases, where the difference in time in transport probably did make a difference.

One of those Airlift NW losses was an OB patient from Bainbridge.  The helicopter went down in Puget Sound with the loss of all souls on board and the aircraft. The patient wanted to be delivered by her own doctor at Swedish as opposed to going to Harrison hospital, and it was not a case in which the patient or the baby was in medical distress.

I have read some data over the years suggesting that about one-third of all aeromedical evacuations are done for things like difficult terrain, distance from the hospital and acute trauma or medical conditions in which minutes can make a difference.  Two-thirds of all aeromedical evacuations do not have that level of clinical justification.

[MechAg94]

A fellow engineer broke his leg in the plant some years ago when I was right out of school.  This was in Pasadena, TX over on the Clear Lake side.  The break was nasty and they needed to take him to the Houston Medical Center near downtown Houston.  I heard the rules would not allow them to transport an emergency patient from the suburbs into the downtown Houston by ambulance.  They had to do helicopter transport.  The helicopter landed on the road just outside the plant.

I can understand that during rush hour times, but maybe they don't want local people making a bad call and end up taking an 90 minutes to get 20 miles. 

On the other side, the current Houston political management keeps spending money on everthing but road repairs so maybe they know road transport is potentially dangerous.

[lupinus]

Overuse is often of having a shiny toy and needing to use it often enough to justify the budget.

If its flying multiple times a day it looks much better on budget work ups than its sitting in the pad flying the maybe once a week or so its actually a better option.

[BobR]

When I worked on the rez we did tons of air ambulance transfers. From where I was at, both Great Falls and Kalispell was right at 1 hour by helo. Ground could take up to 3 hours if they didn't hit an animal and the roads were clear. If we had to send a patient to Harborview or SLC we would do a 40 minute ground ride to the nearest town with a runway the fixed wing transport could operate from. There it was needed.

Not so much in Spokane where I have flown patients less than 10 miles. By the time we did everything we needed to do to get the helo on site we could have already had them at the bigger place using ground transport. But then depending on the patient you get into ground critical care transport and it takes quite a bit longer to get the correct crew dispatched. You just never know which is best so you normally call for the helo and hope they have good insurance. :(

bob

[BlueStarLizzard]

Yeah, but how would you opt out of that kind of service?

That's my issue with this. When you call 911 for emergency services, you're not really in a position to argue with what gets sent to help you.
I'm not saying that you shouldn't pay for services received, but it seems to me that someone could legitimatly say "hey, they took advantage of me when I was incapacitated and are ripping me off."

[Cliffh]

I went to the local clinic for a fairly severe problem, a guy having heart problems was there at the same time.

DW drove me to the associated hospital, about an hour drive.

The other guy took the helicopter.

We got to the ER within minutes of each other.  

Since DW's ambulance ride to the same hospital from the same clinic (a totally unnecessary trip ordered by the clinic) and our paying $1,800 of a $3,000 bill we've found that the ambulance company offers an "insurance" policy.  $48 per year (for the entire family) will get you a free ride in the ambulance.

We paid the $48 for this year.

Yeah, but how would you opt out of that kind of service?

That's my issue with this. When you call 911 for emergency services, you're not really in a position to argue with what gets sent to help you.
I'm not saying that you shouldn't pay for services received, but it seems to me that someone could legitimatly say "hey, they took advantage of me when I was incapacitated and are ripping me off."

That was the problem with DW's ride.  She wanted me to drive her, (I was ~4 mi away at another doc's office), the clinic staff stuffed her into the ambulance anyway saying something about how I wouldn't be able to provide the appropriate services she might need en-route.  The kicker was, they assumed she was having a "heart event", turns out it was simply allergies cleared up by an injection (at the same *expletive deleted*ing clinic) 2 days later.

[Boomhauer]

We never called for medevac unless it was very necessary. It made the difference several times.

[RoadKingLarry]

I'll check with little brother to see if he's gotten the bill for his latest helicopter ride yet. From the ER he went to  the hospital the hospital they flew him to is about 20-ish road miles. It was done on a Sunday afternoon and traffic in Tulsa would not have been a major issue. My educated guess based on the road route is that if they had loaded him into an ambulance at the same time they made the call for the helo he would have been in the Tulsa hospital sooner by ambulance.

Last time the ambulance came and picked him up at my house, took him the 20 miles to the nearest ER then helo'd him into Tulsa. Since they picked him up at my house they tried to send me the bill for the ambulance and helo ride....

[Neemi]

I don't know what the bills run, but they can't be cheap.

One of my last shifts, I got the heads up that a patient was coming in by chopper. The reported injury was an amputation.




It was an amputated fingertip.

 

[Jamisjockey]

If you saw the number of medical helos working around any given large metro area most nights you'd be in shock.

[Perd Hapley]

https://www.youtube.com/watch?v=9z5FXytWh3k

For many health systems in urban environments, having a helicopter is an expensive shiny status symbol that helps you stand out from the competition.  Much the same reasoning used by local TV stations to buy a helicopter.

The St Louis Fox affiliate has a helicopter, but they went one better - they got a boat. Yeah, a news-boat. They called it Riverfox, or Waterfox, or something. I haven't heard anything about it since they got it a couple of years ago, so I think they got rid of it.

[AmbulanceDriver]

Portland has really only one helo provider for air ambulance service - Lifeflight.  There are several local and regional fixed wing providers that we also work with.   

Having said that, our rule is that to call the bird, you have to have a critical patient, and it has to save at least 15 minutes from the scene to the hospital.  That includes the flight time to the scene...   Guideline is that you have to be at least 45 mins out by ground to even really consider it.

One of the counties has a protocol that any crash on rural highways, or other serious call based on initial triage by the 911 center will automatically put the bird on standby - this means the crew gets their gear, loads up in the helo, they preflight it, and get the engines warmed up.  That saves at least 5-10 minutes on the response time.   

There are the situations where even fairly close, it makes sense to get the bird inbound....  We had a rollover crash where the patient was ejected from the truck that was only 8 or so miles away from the nearest trauma center.  BUT....  It was rush hour, and we'd have been fighting traffic all the way in to town.  The bird was put on standby based on the ejection.  And we were only 5 minutes away by air from their base, so as soon as we got on scene and evaluated the patient, we activated them.  They landed before we even got the patient fully packaged, right on the freeway, so we didn't have to transport him to a separate LZ, loaded up, and were off the ground 10 minutes later.  Driving to the hospital, even with lights and sirens, in that traffic would have taken a minimum of 45 minutes.   He landed at the ER 6 minutes after takeoff, and was in the OR 10 minutes after that for a flail chest, hemopneumothorax, and a basilar skull fx. 

Then there's the opposite of that - we had a call at a youth camp for troubled youth.   15 y/o girl had fallen off a horse....  Onto sawdust....  In a padded horse arena....   At least 6 inches of sawdust....  :)  She claimed she hit her head, and had "blacked out".... Well, that got the volunteer firefighter/EMT all worked up, and he activated Lifeflight even before we were on scene.   She was conscious, alert, oriented, with a GCS of 15.  No sign of trauma on her head, or anywhere at all for that matter.   Basically a case of Status Dramaticus.   The funny part (if there is one) of that story is that as the helicopter was inbound, they radioed for a patient report.  And my partner and I let the Danger Ranger handle it - we weren't touching this one with a 10 foot pole....   So sure enough, he's giving report to the flight nurse, and says the patient has a GCS of 15.   Which is absolutely perfectly normal, no impairment....   And the nurse comes back on the radio, sounding incredulous, saying, "Just confirming, that GCS was 15???"....  When they landed, she asked my partner and I why we activated them - we just pointed at the fire guy who was now trying to hide behind his fire truck...  And that poor kid's parents got a bill for something around $10k because some volunteer EMT had a hard-on for watching the helicopter come in......

[French G.]

I feel like I live in an area where air transport makes sense. 1 to 1.5+ hours by windy mountain roads to get to the closest ER, 2.5 to get to a good one. Factor in the volunteer EMS response before any transport starts and you are pretty much blown on the whole golden hour bit. The county has several designated LZs, wish I had known that I lived next to one before the 3am lights, sirens, and hovering helos shortly after I moved in. I was really wondering how they found out about me so fast.

[lupinus]

In instances like sawdust girl I fully support the patient/patients family not being on the hook for the bill.

[K Frame]

My Father's trip via air ambulance was absolutely necessary. He had an unstable neck fracture.

Getting him from the small local hospital to the major regional medical center where they could treat him presented two choices:

1. A 25 minute flight via helicopter

2. A likely 2-hour ambulance ride over bumpy, windy country roads, at night, in winter.

[RevDisk]

I feel like I live in an area where air transport makes sense. 1 to 1.5+ hours by windy mountain roads to get to the closest ER, 2.5 to get to a good one. Factor in the volunteer EMS response before any transport starts and you are pretty much blown on the whole golden hour bit. The county has several designated LZs, wish I had known that I lived next to one before the 3am lights, sirens, and hovering helos shortly after I moved in. I was really wondering how they found out about me so fast.

That must have been an interesting night. You should put up a wind sock. Seriously, never hurts to be on good terms with medevac. I used to donate Cuban cigars to mine.

[lee n. field]

I don't know what the bills run, but they can't be cheap.

One of my last shifts, I got the heads up that a patient was coming in by chopper. The reported injury was an amputation.




It was an amputated fingertip.

 

 

My Dad lost a fingertip.   Back in the 30s or 40s sometime.  Grandma sewed it back on.   (It didn't work.)

[41magsnub]

We had a bunch of people abusing the air ambulance last year.  Remember the mega-loads?  The refinery equipment being trucked up to Canada via secondary roads?  While in motion, they completely blocked all other traffic on the road.  Folks with no alternate route were promised that the company would cover air ambulance if they had a medical issue while the roads were blocked.  Also, they covered a standby ambulance parked on the far side of the blockage.  Several folks waited until the trucks were in motion, then called 911 complaining of chest pains. 

Now, my cousin is a flight medic.  He told me that the ones he responded on were either faking or had mild gas at worst.  Of course they still had to transport them and all that.

[lee n. field]

We had a bunch of people abusing the air ambulance last year.  Remember the mega-loads?  The refinery equipment being trucked up to Canada via secondary roads?  While in motion, they completely blocked all other traffic on the road.  Folks with no alternate route were promised that the company would cover air ambulance if they had a medical issue while the roads were blocked.  Also, they covered a standby ambulance parked on the far side of the blockage.  Several folks waited until the trucks were in motion, then called 911 complaining of chest pains. 

Now, my cousin is a flight medic.  He told me that the ones he responded on were either faking or had mild gas at worst.  Of course they still had to transport them and all that.

Free helicopter ride?

[230RN]

Yeah, but how would you opt out of that kind of service?

That's my issue with this. When you call 911 for emergency services, you're not really in a position to argue with what gets sent to help you.
I'm not saying that you shouldn't pay for services received, but it seems to me that someone could legitimatly say "hey, they took advantage of me when I was incapacitated and are ripping me off."

I was thinking along the same direction.  I recognize that in many cases a helicopter transfer would be necessary.

But I wondered what kind of message you could keep on your person which would tell them not to screw with air medevac unless it was genuinely necessary.

Kind of a vague question, especially since "genuinely necessary" is a matter of opinion, and obviously first responders would rather err on the side of caution.

Hmmmm.....

Terry, 230RN