#Helicopter medevac, a complicated industry

After World War II, the medical industry and hospitals grew rapidly because of new knowledge gained in the war. We learned how to do surgeries that we never did before, and developed new antibiotics, new medicines and new and expensive equipment. Over the years, we experienced an economy with spiraling costs for everything from cotton balls to hospital beds, and high tech equipment that is used to practically keep tabs on every cell in the body. This has made it difficult for many smaller hospitals to keep pace. When hospital beds are not full, revenue is down. Added to this are new ways of treating patients on an outpatient basis as opposed to inpatient. New medicines and technology has also tended to shorten hospital stays; even patients who have undergone surgery no longer stay in the hospital very long. All of these factors have made for a climate in which many hospitals and practitioners have literally had to fight for survival.

The general helicopter industry had comparable experiences in their growth and decline. Historically, helicopters have been a vehicle of the military, and later metropolitan police departments for use in traffic control and surveillance. One of the largest users of helicopters has been the oil industry for exploration. A worldwide slump in oil prices managed to drive many helicopter companies out of business. However, helicopter vendors who refused to become a dying statistic flocked to the medevac industry.

Since 1980, there has been a boom in EMS helicopter services as new programs have sprung up to get in on what has looked like a lucrative market. Where there had only been one or two services there are many. This sudden change of events caused the helicopter medevac industry to grow up Willie Nillie with no particular design or guidelines. Standards were not determined for conduct, staff qualifications, or equipment for air ambulances.

On the medical side, there was no legislation to clearly designate trauma centers and enforce health standards and conduct.

In 1980, only 30 helicopter medevac programs existed in the United States. According to Hospital Aviation Magazine, the first five years of the ‘80s saw the creation of more than 80 new programs. Today, in 2014, there are over 800. This has made for a climate of cutthroat competition for both helicopter operators and hospitals who were eager to cash in on what looked like a lucrative market. Those who have been able to enter the medevac industry have been able to keep their ships flying. At the same time, hospitals have a highly visible marketing tool and the capability of increasing their sphere of influence to take on many more patients. Fast and furious competition forced hospitals to develop a helicopter service just to keep a toehold in their own area.

A virtual explosion in growth created an industry with an almost total lack of federal or state regulations in either the medical or aviation arena. This resulted in minimal control over who flies, what they fly, or where they take the patient.

It can cost a hospital $60,000 or more a month to operate a helicopter. At the same time, severe trauma cases can draw $18,000-$26,000 in revenue for direct patient services. For a hospital to enter the trauma care arena under the best of circumstances, it can easily cost a million dollars. Not all hospitals with helicopter programs have elected to go into the business of being a bona fide trauma care facility. Further, it would not be cost effective for every hospital to become a trauma center. Still, it is difficult for some to forego the temptation to pick up trauma revenue.

Helicopters are secondary responders called in by another authority who has determined that a helicopter is necessary. Very quickly, which helicopter service is called to the scene, and where the victim is taken becomes a crucial issue for those wishing to gain their share of the market. This is a highly controversial issue whether one is concerned about economic survival or the best interests of the victim. Many have reared up in protest to demand that standards be met before a hospital can be designated as a trauma center capable of ministering to the needs of the critically injured.

On the helicopter side of things, is the question of who is qualified to transport a critically ill or injured patient. What kind of personnel and equipment is on board, and where is the patient taken. If competing helicopter services are within the same general vicinity, the situation can become more complicated. Paramedics and EMTs who arrive at the scene first suddenly become very powerful. Social, political and economic variables can run rampant, and have an impact on how a trauma case is handled.

The marriage of the helicopter to the hospital industry has not been without passion, controversy, and irony. Just about every helicopter medevac program carries a name that conveys benevolent motives of the highest order. Still, it is in the public’s best interest to ask: Are they really as good as they sound? Do they serve the best interest of the critically ill or injured?

After World War II, the medical industry and hospitals grew rapidly because of new knowledge gained in the war. We learned how to do surgeries that we never did before, and developed new antibiotics, new medicines and new and expensive equipment. Over the years, we experienced an economy with spiraling costs for everything from cotton balls to hospital beds, and high tech equipment that is used to practically keep tabs on every cell in the body. This has made it difficult for many smaller hospitals to keep pace. When hospital beds are not full, revenue is down. Added to this are new ways of treating patients on an outpatient basis as opposed to inpatient. New medicines and technology has also tended to shorten hospital stays; even patients who have undergone surgery no longer stay in the hospital very long. All of these factors have made for a climate in which many hospitals and practitioners have literally had to fight for survival.

The general helicopter industry had comparable experiences in their growth and decline. Historically, helicopters have been a vehicle of the military, and later metropolitan police departments for use in traffic control and surveillance. One of the largest users of helicopters has been the oil industry for exploration. A worldwide slump in oil prices managed to drive many helicopter companies out of business. However, helicopter vendors who refused to become a dying statistic flocked to the medevac industry.

Since 1980, there has been a boom in EMS helicopter services as new programs have sprung up to get in on what has looked like a lucrative market. Where there had only been one or two services there are many. This sudden change of events caused the helicopter medevac industry to grow up Willie Nillie with no particular design or guidelines. Standards were not determined for conduct, staff qualifications, or equipment for air ambulances.

On the medical side, there was no legislation to clearly designate trauma centers and enforce health standards and conduct.

In 1980, only 30 helicopter medevac programs existed in the United States. According to Hospital Aviation Magazine, the first five years of the ‘80s saw the creation of more than 80 new programs. Today, in 2014, there are over 800. This has made for a climate of cutthroat competition for both helicopter operators and hospitals who were eager to cash in on what looked like a lucrative market. Those who have been able to enter the medevac industry have been able to keep their ships flying. At the same time, hospitals have a highly visible marketing tool and the capability of increasing their sphere of influence to take on many more patients. Fast and furious competition forced hospitals to develop a helicopter service just to keep a toehold in their own area.

A virtual explosion in growth created an industry with an almost total lack of federal or state regulations in either the medical or aviation arena. This resulted in minimal control over who flies, what they fly, or where they take the patient.

It can cost a hospital $60,000 or more a month to operate a helicopter. At the same time, severe trauma cases can draw $18,000-$26,000 in revenue for direct patient services. For a hospital to enter the trauma care arena under the best of circumstances, it can easily cost a million dollars. Not all hospitals with helicopter programs have elected to go into the business of being a bona fide trauma care facility. Further, it would not be cost effective for every hospital to become a trauma center. Still, it is difficult for some to forego the temptation to pick up trauma revenue.

Helicopters are secondary responders called in by another authority who has determined that a helicopter is necessary. Very quickly, which helicopter service is called to the scene, and where the victim is taken becomes a crucial issue for those wishing to gain their share of the market. This is a highly controversial issue whether one is concerned about economic survival or the best interests of the victim. Many have reared up in protest to demand that standards be met before a hospital can be designated as a trauma center capable of ministering to the needs of the critically injured.

On the helicopter side of things, is the question of who is qualified to transport a critically ill or injured patient. What kind of personnel and equipment is on board, and where is the patient taken. If competing helicopter services are within the same general vicinity, the situation can become more complicated. Paramedics and EMTs who arrive at the scene first suddenly become very powerful. Social, political and economic variables can run rampant, and have an impact on how a trauma case is handled.

The marriage of the helicopter to the hospital industry has not been without passion, controversy, and irony. Just about every helicopter medevac program carries a name that conveys benevolent motives of the highest order. Still, it is in the public’s best interest to ask: Are they really as good as they sound? Do they serve the best interest of the critically ill or injured?

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#Trauma center designation

In 2013, Dr. Christopher Urbina, former executive director and chief medical officer of the   Colorado Department of Public Health and Environment announced that the criteria for Level I designation as a trauma center would be reduced to treating 320 critically injured patients per year.   Research has demonstrated that centers that treat 600 critically injured per year have the best outcomes because it keeps their skills sharp. As other hospitals gear up to be designated trauma centers, this may be another case of too much competition at great expense.   The over designation of trauma centers would require Level I and II service to have to pay to have surgeons and other healthcare providers on call to assure that each hospital is prepared to provide intervention for the seriously injured 24 hours a day/ 365 days a year.   In essence the proposed change would simply increase competition and result in a duplication of services that drive up costs and dilute the quality of trauma care for Coloradoans.   Most trauma experts believe a population of 2.5 million in the Denver metro area justifies just a single Level I Trauma Center, not the three that we presently have.

In 2009 the American College of Surgeons conducted a comprehensive review of the Colorado Trauma System and completed with the assessment that it “likely reflects an excess of trauma centers that are competing for patients, reducing the volume at each center, and duplicating expensive resources.”

#Helicopter transport and #obesity

The National Center for Health Statistics reports obesity in America has reached alarming rates. It is one of the biggest drivers of healthcare costs that are estimated to range from $147 billion to nearly $210 billion per year. 68.5% of adults are overweight and 34.9% are obese. Obesity among children and adolescents has escalated. 31.8% are overweight and 16.9% are obese. This is alarming and preventable. Certainly obesity has a negative effect as it increases diabetes and other health conditions.

In a critical care situation where a helicopter is called for transport, it is estimated 5,000 US patients are denied helicopter transport each year because they are too heavy or large to fit in an aircraft. This has created a dilemma for air transport providers. In an NBC report, Craig Yale, vice president of corporate development for Air Methods said, “It’s an issue for sure. We can get to a scene and find the patient is too heavy to be able to go.”    If a patient is too large or heavy to fit in the helicopter, they may not be able to receive the urgent care they need in a fast enough manner. In some cases patients simply cannot fit through the doors. In some instances, an overweight person may be able to fit into the aircraft, but their weight can sometimes prevent a helicopter from lifting off the ground.  This can pose a dangerous risk to all on board. A helicopter crashed in New York’s East River in October 2011 because it was over capacity by 50 pounds.

Americans seem to be sleep walking as they go about getting larger and larger compromising their health and setting poor examples for their children.   Helicopter transport services face having to deny service or invest in larger helicopters.   Obesity is something we need to address in schools and various healthcare facilities by focusing on the problem and teaching sound nutrition.   It can be difficult because when you attempt to mention the problem, a person may feel insulted and defensive. Still, programs need to be set in place to prevent this condition. It’s in everyone’s best interest.

 

#helicopter transport

Student in Murrysville Pa  at Franklin regional high school suffered a head injury in physical education playing volley ball.  Medics in the interest of “abundance of caution”  had him transported by helicopter.  In this instance,  possibly erring on the side of caution was a good thing.  Potential brain injury is a critical concern.  Other questions to consider:  Time and distance to critical care and the ability of the facility to deal with this kind of injury.  If all that is in line, it is good the medics had the ability and courage to make the right call. .