Helicopter medevac: an industry plagued with controversy

In the 1980s the Golden Hour concept of sixty crucial minutes to definitive care was the life-saving ingredient. The speed of helicopter vs. the time travel of an ambulance was touted as being the key factor in saving lives. Now (2014) there are studies questioning this. In many instances, the helicopter has not been any faster than an ambulance, because there are times when a helicopter may be physically some distance away from the victim. Ostensibly, the mission is one of saving lives. Nonetheless, there is great debate about whether or not this is really the case. As stated before, EMS helicopter medevac programs exploded as more and more hospitals felt the need to extend their services. Presently, there are 850 helicopter programs. Medical helicopters transport 400,000 patients annually. At the same time these services that are intended to be life-saving are sadly crashing and claiming the lives of both patients, medical crew and pilots.

It is difficult to imagine an industry more plagued with controversy than that of civilian helicopter medevac.   The reason for this is:

  • The Journal of American Medical Association found that 50 million people are injured in the U.S. per year. 169,000 die from injury.   A helicopter trip can cost from $5000 to $10,000 while an ambulance costs $500 to $1500. Data indicated $350,000 would have to be spent to save one life.   Helicopters are expensive vehicles and can cost up to a million dollars a year per aircraft to operate. This said, a significant amount of financial resources are going into a transport modality that actually benefits few patients. This money could better be spent to benefit more people. Several recent studies have shown that helicopter transport for trauma patients only benefited a small number of patients.
  • There is a proliferation of medical helicopters in urban areas, but far fewer where they could better serve those in rural areas.   The North East has the highest number of medical helicopters.   There seems to be no correlation between population density, general medical access or medical need. There are between 26 and 45 helicopters in smaller states.   Kentucky has 26 while Canada with a population of 30 million only has 20 medical helicopter services.
  • Some claim the victims injuries did not warrant the being transported by helicopter. Researchers in Silicon Valley in California (Shatney) reviewed 947 consecutive trauma transports and found 22.8% benefited from helicopter transport. They also found that 33.5% of the patients transported by helicopter were discharged from the ER and not admitted to the hospital. A Boston study of 1,523 patients transported by helicopter found 24% of the patients transported from an accident scene were inappropriate. (Reenstra WR) Similar findings exist in other countries. The facts do not support the need for a higher number of helicopter services. In urban areas, a well- equipped ambulance with trained staff on board can be as effective. Helicopters may not really save time because landing a helicopter in an urban area can be difficult.
  • It is said that being an EMS helicopter pilot is one highest risk jobs there is when compared with other industries.
  • A 5 year study (Schiller) in Phoenix Arizona involving blunt-trauma patients transported either by helicopter or ground ambulance found no survival advantage for patients transported by helicopter in that urban setting with a sophisticated pre-hospital care system.
  •  Ambulances are first responders and call in a helicopter if they feel it is advisable. Some studies indicate that EMS providers may call in a medical helicopter when the patient’s condition does not warrant it. Some people feel that medics are calling helicopters so that they can keep their ambulances in circulation.
  • Instead of being parked on top of a hospital in an urban area, helicopter services would be more appropriate serving people who need them most — those in a rural area.
  • Over the last decade there has been an escalation of helicopter accidents in the U.S. 83 accidents.   Jon Hilkevitch, reported in the Tribune “more than 100 people have died in helicopter crashes since 2003.”
  • An eight-year study in Pennsylvania looking at 3,048 victims transported by helicopter had longer transport times with no significant difference in mortality when compared to ground transport.
  • The National Traffic and Safety Board as well as the Federal Aviation Association is not effectively dealing with the ongoing troubles plaguing the industry. Recommendations for night-vision goggles; has not been implemented for several reasons. The military has first priority in acquiring these goggles and there are only a couple of companies manufacturing them. Further, it cost about $60,000 to train two pilots and retrofit the cockpit with this technology. 52 people have died in EMS flight accidents since the NTSB made the recommendations in 2006. So here we have a situation where it is up to helicopter medevac services to implement recommendations or not implement them. There is no significant power to enforce safety standards. Further, studies have shown that many helicopter ambulance trips are medically unnecessary and expose patients and crew to unnecessary risk.
  • There are areas where seriously injured Americans would have no access to a Level I or II trauma center within an hour. Sharing resources would make more sense than competition.  Thinking strategically instead of practicing egonomics, these agents could find ways to come to agreements to share resources and potentially create a win win situation for hospitals and patients alike.  Making sure that everyone has “affordable health care insurance” may even prompt even more aggressive competition.   It may be time for a concerned public to demand more responsible behavior in an industry that ostensibly wants to save lives.
  • The FAA through examination of air ambulance accidents from 1991 through 2010, determined 62 accidents that claimed the lives of 125 people could have been mitigated by the implementation of a new rule. In 2014, The FAA issued a final rule to improve helicopter safety. FAA Administrator Michael Huerta said, “This rule will help reduce risk and help pilots make good safety decisions through the use of better training, procedures, and equipment. Within three years of this decision, helicopter air ambulances must use the latest on-board technology for terrain awareness and warning systems.   Within four years, they must be equipped with flight data monitoring systems. This includes equipping helicopters with radio altimeters. Use higher weather minimums and require that all pilots are tested to demonstrate competency in recovery in an inadvertent encounter in change of meteorological conditions. Further they must implement pre-flight risk-analysis programs.
  • .

 

 

In the 1980s the Golden Hour concept of sixty crucial minutes to definitive care was the life-saving ingredient. The speed of helicopter vs. the time travel of an ambulance was touted as being the key factor in saving lives. Now (2014) there are studies questioning this. In many instances, the helicopter has not been any faster than an ambulance, because there are times when a helicopter may be physically some distance away from the victim. Ostensibly, the mission is one of saving lives. Nonetheless, there is great debate about whether or not this is really the case. As stated before, EMS helicopter medevac programs exploded as more and more hospitals felt the need to extend their services. Presently, there are 850 helicopter programs. Medical helicopters transport 400,000 patients annually. At the same time these services that are intended to be life-saving are sadly crashing and claiming the lives of both patients, medical crew and pilots.

It is difficult to imagine an industry more plagued with controversy than that of civilian helicopter medevac.   The reason for this is:

  • The Journal of American Medical Association found that 50 million people are injured in the U.S. per year. 169,000 die from injury.   A helicopter trip can cost from $5000 to $10,000 while an ambulance costs $500 to $1500. Data indicated $350,000 would have to be spent to save one life.   Helicopters are expensive vehicles and can cost up to a million dollars a year per aircraft to operate. This said, a significant amount of financial resources are going into a transport modality that actually benefits few patients. This money could better be spent to benefit more people. Several recent studies have shown that helicopter transport for trauma patients only benefited a small number of patients.
  • There is a proliferation of medical helicopters in urban areas, but far fewer where they could better serve those in rural areas.   The North East has the highest number of medical helicopters.   There seems to be no correlation between population density, general medical access or medical need. There are between 26 and 45 helicopters in smaller states.   Kentucky has 26 while Canada with a population of 30 million only has 20 medical helicopter services.
  • Some claim the victims injuries did not warrant the being transported by helicopter. Researchers in Silicon Valley in California (Shatney) reviewed 947 consecutive trauma transports and found 22.8% benefited from helicopter transport. They also found that 33.5% of the patients transported by helicopter were discharged from the ER and not admitted to the hospital. A Boston study of 1,523 patients transported by helicopter found 24% of the patients transported from an accident scene were inappropriate. (Reenstra WR) Similar findings exist in other countries. The facts do not support the need for a higher number of helicopter services. In urban areas, a well- equipped ambulance with trained staff on board can be as effective. Helicopters may not really save time because landing a helicopter in an urban area can be difficult.
  • It is said that being an EMS helicopter pilot is one highest risk jobs there is when compared with other industries.
  • A 5 year study (Schiller) in Phoenix Arizona involving blunt-trauma patients transported either by helicopter or ground ambulance found no survival advantage for patients transported by helicopter in that urban setting with a sophisticated pre-hospital care system.
  •  Ambulances are first responders and call in a helicopter if they feel it is advisable. Some studies indicate that EMS providers may call in a medical helicopter when the patient’s condition does not warrant it. Some people feel that medics are calling helicopters so that they can keep their ambulances in circulation.
  • Instead of being parked on top of a hospital in an urban area, helicopter services would be more appropriate serving people who need them most — those in a rural area.
  • Over the last decade there has been an escalation of helicopter accidents in the U.S. 83 accidents.   Jon Hilkevitch, reported in the Tribune “more than 100 people have died in helicopter crashes since 2003.”
  • An eight-year study in Pennsylvania looking at 3,048 victims transported by helicopter had longer transport times with no significant difference in mortality when compared to ground transport.
  • The National Traffic and Safety Board as well as the Federal Aviation Association is not effectively dealing with the ongoing troubles plaguing the industry. Recommendations for night-vision goggles; has not been implemented for several reasons. The military has first priority in acquiring these goggles and there are only a couple of companies manufacturing them. Further, it cost about $60,000 to train two pilots and retrofit the cockpit with this technology. 52 people have died in EMS flight accidents since the NTSB made the recommendations in 2006. So here we have a situation where it is up to helicopter medevac services to implement recommendations or not implement them. There is no significant power to enforce safety standards. Further, studies have shown that many helicopter ambulance trips are medically unnecessary and expose patients and crew to unnecessary risk.
  • There are areas where seriously injured Americans would have no access to a Level I or II trauma center within an hour. Sharing resources would make more sense than competition.  Thinking strategically instead of practicing egonomics, these agents could find ways to come to agreements to share resources and potentially create a win win situation for hospitals and patients alike.  Making sure that everyone has “affordable health care insurance” may even prompt even more aggressive competition.   It may be time for a concerned public to demand more responsible behavior in an industry that ostensibly wants to save lives.
  • The FAA through examination of air ambulance accidents from 1991 through 2010, determined 62 accidents that claimed the lives of 125 people could have been mitigated by the implementation of a new rule. In 2014, The FAA issued a final rule to improve helicopter safety. FAA Administrator Michael Huerta said, “This rule will help reduce risk and help pilots make good safety decisions through the use of better training, procedures, and equipment. Within three years of this decision, helicopter air ambulances must use the latest on-board technology for terrain awareness and warning systems.   Within four years, they must be equipped with flight data monitoring systems. This includes equipping helicopters with radio altimeters. Use higher weather minimums and require that all pilots are tested to demonstrate competency in recovery in an inadvertent encounter in change of meteorological conditions. Further they must implement pre-flight risk-analysis programs.
  • .

 

 

In the 1980s the Golden Hour concept of sixty crucial minutes to definitive care was the life-saving ingredient. The speed of helicopter vs. the time travel of an ambulance was touted as being the key factor in saving lives. Now (2014) there are studies questioning this. In many instances, the helicopter has not been any faster than an ambulance, because there are times when a helicopter may be physically some distance away from the victim. Ostensibly, the mission is one of saving lives. Nonetheless, there is great debate about whether or not this is really the case. As stated before, EMS helicopter medevac programs exploded as more and more hospitals felt the need to extend their services. Presently, there are 850 helicopter programs. Medical helicopters transport 400,000 patients annually. At the same time these services that are intended to be life-saving are sadly crashing and claiming the lives of both patients, medical crew and pilots.

It is difficult to imagine an industry more plagued with controversy than that of civilian helicopter medevac.   The reason for this is:

  • The Journal of American Medical Association found that 50 million people are injured in the U.S. per year. 169,000 die from injury.   A helicopter trip can cost from $5000 to $10,000 while an ambulance costs $500 to $1500. Data indicated $350,000 would have to be spent to save one life.   Helicopters are expensive vehicles and can cost up to a million dollars a year per aircraft to operate. This said, a significant amount of financial resources are going into a transport modality that actually benefits few patients. This money could better be spent to benefit more people. Several recent studies have shown that helicopter transport for trauma patients only benefited a small number of patients.
  • There is a proliferation of medical helicopters in urban areas, but far fewer where they could better serve those in rural areas.   The North East has the highest number of medical helicopters.   There seems to be no correlation between population density, general medical access or medical need. There are between 26 and 45 helicopters in smaller states.   Kentucky has 26 while Canada with a population of 30 million only has 20 medical helicopter services.
  • Some claim the victims injuries did not warrant the being transported by helicopter. Researchers in Silicon Valley in California (Shatney) reviewed 947 consecutive trauma transports and found 22.8% benefited from helicopter transport. They also found that 33.5% of the patients transported by helicopter were discharged from the ER and not admitted to the hospital. A Boston study of 1,523 patients transported by helicopter found 24% of the patients transported from an accident scene were inappropriate. (Reenstra WR) Similar findings exist in other countries. The facts do not support the need for a higher number of helicopter services. In urban areas, a well- equipped ambulance with trained staff on board can be as effective. Helicopters may not really save time because landing a helicopter in an urban area can be difficult.
  • It is said that being an EMS helicopter pilot is one highest risk jobs there is when compared with other industries.
  • A 5 year study (Schiller) in Phoenix Arizona involving blunt-trauma patients transported either by helicopter or ground ambulance found no survival advantage for patients transported by helicopter in that urban setting with a sophisticated pre-hospital care system.
  •  Ambulances are first responders and call in a helicopter if they feel it is advisable. Some studies indicate that EMS providers may call in a medical helicopter when the patient’s condition does not warrant it. Some people feel that medics are calling helicopters so that they can keep their ambulances in circulation.
  • Instead of being parked on top of a hospital in an urban area, helicopter services would be more appropriate serving people who need them most — those in a rural area.
  • Over the last decade there has been an escalation of helicopter accidents in the U.S. 83 accidents.   Jon Hilkevitch, reported in the Tribune “more than 100 people have died in helicopter crashes since 2003.”
  • An eight-year study in Pennsylvania looking at 3,048 victims transported by helicopter had longer transport times with no significant difference in mortality when compared to ground transport.
  • The National Traffic and Safety Board as well as the Federal Aviation Association is not effectively dealing with the ongoing troubles plaguing the industry. Recommendations for night-vision goggles; has not been implemented for several reasons. The military has first priority in acquiring these goggles and there are only a couple of companies manufacturing them. Further, it cost about $60,000 to train two pilots and retrofit the cockpit with this technology. 52 people have died in EMS flight accidents since the NTSB made the recommendations in 2006. So here we have a situation where it is up to helicopter medevac services to implement recommendations or not implement them. There is no significant power to enforce safety standards. Further, studies have shown that many helicopter ambulance trips are medically unnecessary and expose patients and crew to unnecessary risk.
  • There are areas where seriously injured Americans would have no access to a Level I or II trauma center within an hour. Sharing resources would make more sense than competition.  Thinking strategically instead of practicing egonomics, these agents could find ways to come to agreements to share resources and potentially create a win win situation for hospitals and patients alike.  Making sure that everyone has “affordable health care insurance” may even prompt even more aggressive competition.   It may be time for a concerned public to demand more responsible behavior in an industry that ostensibly wants to save lives.
  • The FAA through examination of air ambulance accidents from 1991 through 2010, determined 62 accidents that claimed the lives of 125 people could have been mitigated by the implementation of a new rule. In 2014, The FAA issued a final rule to improve helicopter safety. FAA Administrator Michael Huerta said, “This rule will help reduce risk and help pilots make good safety decisions through the use of better training, procedures, and equipment. Within three years of this decision, helicopter air ambulances must use the latest on-board technology for terrain awareness and warning systems.   Within four years, they must be equipped with flight data monitoring systems. This includes equipping helicopters with radio altimeters. Use higher weather minimums and require that all pilots are tested to demonstrate competency in recovery in an inadvertent encounter in change of meteorological conditions. Further they must implement pre-flight risk-analysis programs.
  • .

 

 

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Curbing #violence

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