How trauma center designation happened in Colorado

Annie Johnson (a pseudo name) had just won the title of Roundup Rodeo Queen for 1993, and had just been crowned Homecoming Queen at her high school.   She was embarking on one of the most exciting times of her life; she’d earned it all.  Annie was a senior, a good student, active in 4-H and volley ball; actively participated in rodeo competition, and community activities making sure she always did her part.  Everyone in her community, young and old, knew her because she was so full of life; they all loved her.   Those who knew Annie described her as, “a very determined person, always willing to go that extra mile; she was no cream puff queen, but a real person.”  At 14 years of age, Annie could drive a trailer loaded with cattle to help make her family’s ranch work.  Even covered with manure from head to toe, she was still the prettiest, most delightful one around.

                In the fall of 1992, Annie and her boyfriend, set out for a birthday celebration.  After a few hours of great fun, they were traveling back to their rural home on highway 285 around 7:30 p.m.  The young man was at the wheel driving about 45 mph on a dark night with blinding cars coming his way.  In attempt to try to be safe, he decided to pull off to the side of the road into the emergency lane.  When he did, he plowed right into a huge van parked in that same lane.  Neither of them had been able to see the van before he exited; they were not wearing seat belts.  Not much time passed before, they were discovered by some classmates.  Immediately, they realized Annie was seriously injured; the boyfriend had only minor injuries.  The helpers went to a friend’s house to call for help, and to notify Annie’s family.  A 911 emergency number is not in place in this area.  Annie was taken to a community hospital in rural Colorado.  Annie was examined and x-rayed at the same hospital, and found to be more than they could adequately handle.  Life threatening lung and heart bruises were suspected.  Possibly, there was an aortic rupture; this would mean open heart surgery.  “Where would you like to have her taken?” the doctor asked.  Of course, the parents had no idea what would be best for Annie, but were relieved by the possibility that she could be air lifted to Denver.

                The physician summoned a helicopter and conveyed his suspicions to the receiving hospital’s pulmonary and cardiac specialists.  In this instance, this helicopter service had a greater ETA (estimated time of arrival to a rural Colorado hospital and back to take the victim to their hospital base.  While this same hospital has an emergency room, it was not certified to treat trauma victims.  A better option would have to summon a closer helicopter service and have Annie flown to a geographically closer trauma center either in Colorado Springs or Grand Junction. 

                At the time of this incident, physicians in Colorado decided on a case by case basis how they would handle accident victims.  Had a state-wide trauma system with a non-partisan communications network been in place, information about Annie’s injuries would have been fed into a computer.  When and where Annie’s care would have taken place would have been dictated by law.  The victim would not have been flown past hospitals better qualified to treat her critical injuries.  A helicopter with a closer ETA would have been employed.  Annie was transferred to a Denver hospital around midnight where she was taken to an ICU (intensive care unit) where she was met by two resident pediatricians.  While these physicians were probably adept in their own specialties, they were not trauma specialists.  According to medical personnel who saw Annie, she was alert, and talking; she underwent some tests and treatment.  Annie was then put to bed in the ICU without full evaluation of her catastrophic injuries. Around 6-6:30 a.m. Annie’s parents signed for blood to draw out of Annie’s back.  A reliable source close to the case said the same thoracic  surgeon alerted hospital staff that night to the severity of Annie’s injuries and volunteered his services noting that –rays showed her chest was full of blood.  This same surgeon went to the ICU three ties offering to help, and was told, “Everything is under control.”

                On the order of an admitting physician, Annie was examined for internal bleeding.  The same physician was quoted as saying, “Put a needle in her chest and see if there is blood.  If it is, call me.”  The procedure was conducted; a liter of blood was removed from the chest cavity, but the physician was not notified.  Eight hours later, Annie went into severe shock; doctors performed emergency surgery taking Annie’s lung out, but they were too late.  Annie Johnson died the next day at 12:30 p.m.  Later the hospital conceded that Annie was, “An apparent victim of miscommunication. Annie’s death would be reviewed as part of the hospital’s quality management program.  The hospital allowed that it handles ‘a wide variety of trauma cases referred to its doctors.  A medical source close to the case said the failure to diagnose Johnson’s key injury –a ruptured thoracic aorta, was ‘inexcusable, indefensible, reprehensible.”  There are those who would argue that Annie’s death was “preventable.”  She would have had a very good chance of surviving had her injuries been correctly diagnosed and open-heart surgery been performed in a timely manner instead putting her to bed for several hours as she bled to death.

                According to Dr. Ernest “Gene” Moore, Chief of Trauma surgery at Denver General Hospital, a torn aorta is the most common cause of death in traffic accidents.    About 85 percent of victims with ruptured aortas die at the scene.  Of those who make to a hospital, 75 percent survive, if their condition is identified and treated within six hours.  Denver General’s Trauma Center has a survival rate of 88 percent in such cases.  Hospitals are to report unusual deaths to the Colorado Health Department within 24 hours; however, this did not happen until the story was disclosed in The Denver Post.  Failure to report the death violated state law.  The Denver Coroner’s Office then requested The Colorado Board of Examiners to investigate Annie’s death because “of the allegation she had not been properly cared for.”   The Johnson family did not learn of disturbing events surrounding their daughter’s death until they were contacted by The Denver Post.  A reporter called and said, “I’d like to come down and talk to you before we print this story.”

The Johnsons were shocked at the inhuman treatment of their daughter.  Later, they said, “It was an unfair question to ask us where Annie should be taken.  We did not know anything about trauma injury.  We had never heard of a trauma system.  We thought everything possible had been done to save her life; we would have been none the wiser if this had not come out in the paper.  Ewe just wish the cardiac physician had trusted his instincts and gone in there to so something to save our daughter.  Annie was referred to the Denver hospital by a physician who knew the hospital was not certified to treat trauma victims; the system let us down.  We don’t think hospitals should have a helicopter program if they are not attached to trauma centers.”

 Lawmaker urged trauma system

                State Senator Dottie Wham introduced trauma bills to the legislature in 1987; she withdrew the bill in face of “extraordinary objection to it from it seemed like everyone.  In 1989, Wham tried again.  The bill was revamped; it made it to the Senate, but died in the House Committee.  Primary opponents of change came from the medical community.  Senator Wham said, “Annie Johnson’s death is a tragic example of the need for a state-wide trauma system.  I felt particularly bad; maybe if I had worked harder, the system would have been in place and this wouldn’t have happened.”

                After this incident, Senator Wham again introduced Trauma Bill 86 to the legislature early in 1993.  In effect, this bill, “Shall develop an integrated sate-wide trauma system which shall, at minimum, provide or promote access to and standards for pre-hospital care, hospital care, rehabilitation care, preventive care, disaster medical care, education, research, communications and costs of trauma care in a manner consistent with recognized national standards for EMS systems.  Such a system shall involve all appropriate health care agencies, institutions, facilities, and providers on the national, state, and local level.”

                When public hearing were held early in 1993, Mr. and Mrs. Johnson were able to testify to the effect that the system had failed them in the treatment of their daughter.  No one opposed the bill; it was accepted. 

                In the gallery of the legislative hearings, Joe Butterfield M.D. of Children’s Hospital in Denver, commented, “It has taken 20 years to get to this point.  There just isn’t any cooperation; it’s a matter of egonomics.  Everyone wants to do their own thing.  We really do need regional care to save lives.” 

                Linda Dodge of the Colorado Trauma Institute said, “We can’t walk away from the fact that half of our trauma patients are dying.  Similar cases happen in other hospitals, not only in Colorado, but all over the country.  We need to get the right patient to the right place at the right time for the right care.”

HIGHER POWER

Screenplay about civilian helicopter medevac:  Higher Power

 Moondance International Screenplay competition finalist. 

Logline:  A rookie flight nurse risks her life to make the public aware  of a hospital’s inability to meet the needs of  the critically injured. 

Synopsis:    Havana, a community hospital launches The Odyssey helicopter to increase its sphere of influence and improve its bottom line.  The hospital administrator’s  edict is:  “Go out haul ‘em in.”    A rookie  flight nurse  obsessed with saving lives strives to make the public aware of the  hospital’s inability to meet the needs of the critically injured.  When the actions of  her eight year old  self-actualizing  daughter  put her at risk, her husband demands she must  come home.   She insists: “Lives are at stake, I can’t.” 

When her daughter is in an accident in the mountains; can Havana hospital save her life  . . .?

Copyright © 2000 All rights reserved. 

This story was born out of my experience in the helicopter medevac  arena with Flight for Life.    If  you would like to  read  the script,  please let me know.    opalmorningstar2@gmail.com     

Medical helicopter viability studies

  • Medical helicopter actually benefit only a small number of patients.    Studies indicated that many EMS providers summon medical helicopters when the patient’s condition may not warrant their use.
  • Only 22.8% of study patients possibly benefited from helicopter transport. They further found that 33.5% of patients transported by helicopter were discharged from the emergency department and not admitted to the hospital; 85% of patients were considered to have minor injuries. Of the patients transported by helicopter in their study, 33% were discharged home from the emergency department and not admitted to the hospital.14
  • Injured children were considered over-triaged.15 A Boston study of 1,523 patients transported by helicopter found that 24% of patients transported from an accident scene were deemed inappropriate.16
  • When the University of Texas Medical Branch at Galveston discontinued its hospital-based air medical helicopter, they found that there was no decrease in transport time or increase in mortality for trauma patients at their facility.21
  • In a North Carolina study, researchers found that only a very small subset of patients transported by helicopter appeared to have any chance of improved survival based on their helicopter transport.23
  • In an eight-year Pennsylvania study of 3,048 penetrating-trauma victims, researchers found that patients transported by helicopter had longer transport times and no significant difference in mortality compared with
  • those transported by ground.26 Likewise, transport of patients with severe head injuries and burns do not appear to benefit from helicopter transport.27,28
  • Furthermore, these studies indicate that many EMS providers summon medical helicopters when the patient’s condition may not warrant their use.
  • Inter-facility transfers between hospitals. Could for the most part just as well been transferred by ambulance.
  • A factor often overlooked is helicopter safety.
  • Significant amount of financial resources are going into a transport modality that actually benefits few patients. These large sums of money would buy many AEDs and ground ambulances that would stand to benefit more of our citizenry. With a dwindling healthcare dollar, we will soon have to make some tough decisions.
  • There certainly is a role for helicopters in EMS, but we have them in the wrong places. The majority of the fleet is parked atop hospitals in urban centers where ground transport takes only minutes. They need to be positioned where they will benefit the people who need them the most–those who live in rural settings
  • Thus, there should be a strategically placed network of helicopters that serves rural hospitals and providers. However, as long as hospitals operate helicopters as “flying billboards,” this will probably never happen.

 

 

 

Emergency air ambulance regulation?

As helicopter medevac has evolved over the years, it has grown to over 1000 helicopters in the United States and are quite competitive.  At the same time they have become controversial in the consumer arena as patients have later received high medical bills they never expected.   It is ironic that the vehicle that has gone out to save a life in a critical life threatening situation,  has many times been in an accident.    A conversation needs to take place about how air ambulances are regulated and how to prevent accidents.

See Pdf:  UP-in-the-air- Inadequate-Regulation-for-emergency-air ambulance

Inadequate regulation of air ambulances

If you are someone who lives in a rural area and have an accident that is life threatening, para-medics are called to assess the situation. If indeed, your injury is a life and death matter, a medical helicopter may be called to transport you to hospital. In this situation, you are at a disadvantage as a patient. You and family are frightened and feel you must rely on the judgment of the medic. In some instances, a helicopter may not be the right decision and may leave the family straddled with an incredible medical bill for transport. One’s insurance may or may not cover helicopter transport. In some instances, a patient may be billed up to $40,000 with no real means to pay for service.   The medical helicopter industry rapidly grew with for-profit carriers. With this came patient consumer complaints and pleas for help as families were dogged for payment they could not meet. Unfortunately federal law has not helped to provide consumer protection. There is inadequate regulation of air ambulances that needs to be addressed at the state level.   The federal Airline Deregulation Act of 1978 preempts states from regulating rates, routes or services of any air carrier. The Department of Transportation concludes that air ambulances are “air carriers.”  Therefore, states are preempted from regulating their services. The big question is how to correct this gap and protect consumers who unsuspected are slammed with an exorbitant bill?

 

Consumer beware

Anyone who has been picked up by a medical helicopter and transported to a hospital after an accident  can come into a big surprise when they get the bill.  Today there is a culture of high competition in a market place that is over gutted with helicopters.  The victim does not call for helicopter service; that decision is made by a first responder who assesses the patient and makes the call for transport.  In some instances,  a helicopter may not have been necessary in the first place.  An ambulance may have been able to transport in a more timely fashion or the victim’s injuries really did not qualify for trauma intervention.  An injury can be a highly emotional situation fed by fear of loss of life.  Typically,  insurance does not provide for helicopter transport and a victim really has no real understanding of what they are in for.  Unfortunately, federal law has often preempted state regulations that might otherwise protect consumers.  Clearly there needs to be some kind of protection in place so that the patient does not end up with extreme medical bills and no way to pay.  Lawsuits abound in the industry.  At this point in time, higher Medicare reimbursement rates along with minimal regulation has transformed an essential life-saving service into one with little oversight, multiple accidents claiming lives and predatory billing practices.

Copyright 2017

 

 

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Air ambulance system out of control

Today there are over 1000 air ambulances in the United States. Competition is fierce as for profit companies are driving out nonprofits. The alarming thing in this industry is how predatory the air ambulance industry has become as they seek to cash in on the injured. In a number of instances, the patient’s location is within a reasonable distance to be transferred by ambulance. Also, patient injuries are not extensive enough to warrant calling for a helicopter.   The patient may arrive at the hospital and then be discharged from the emergency room. A first responder has made a poor judgment in calling for an air ambulance. Tragically, the patient had no say in what took place. The family had no idea that insurance will  not pay for transport and are stuck with a $30,000 bill for the ride. Unfortunately, deregulation of the airline industry left states unable to regulate air ambulance services or protect consumers from predatory practices.

Added to all of this is the dilemma of helicopter safety. Pilots may be under intense pressure to transport and this might affect his judgment. At this point in time, there has been an alarming rate of helicopter accidents that claim the lives of staff and patient.   Clearly, this is an industry with multiple system problems that jeopardize patients and families who are then left with astounding medical bills that are unwarranted.

The big question is: what can be done to change the system and protect the unsuspecting injured and their family?

Copyright 2017

#helicopter safety #helicopter shopping

Given the numerous helicopter accidents one has to wonder how helicopter medevac can really be profitable. Hospitals have, indeed, taken on a chopper with the hope of increasing revenue by extending their reach. A lot of pressures exerted on pilots to fly even when it may not be safe to do so. Staff who eagerly want to be of service, may have clouded judgment. Administrators may have undue pressures on the pilot to perform. Still, it is the pilot who flies and ultimately needs to make the call to go or not go. Other dynamics play into the situation as EMS on the ground shop around and pit one service against another. Competition exists in all industries. In helicopter medevac it is a dangerous game with a great deal of potential for disaster to claim the lives of not only the crew, but the patient they were assumedly trying to rescue. The record speaks for itself. How many lives must be lost before the EMS system comes to its senses and openly deal with the reality of the problem.

Copyright 2017  all rights reserved.

Are #medical #helicopters cost effective

Studies have been done to evaluate whether or not helicopters are cost effective and are really out there saving lives.  In effect,  money  hospitals lose in the helicopter business results in higher costs for other services that will then be passed on to insurance companies or patients.   In fact, there are studies that show patients transported were inappropriate because they were not true trauma cases.   Many were discharged from the emergency department and not hospitalized.   Studies in other countries are revealing similar scenarios.

Given all the recent social political events hitting on us daily, some may be pacing and wonder what’s next.  Healthcare and its cost is definitely on the radar.  Trump has flipped from one position to the opposite on a variety of things.  Social Security and Medicare could potentially be cut by Congress.  When Medicare decided it would pay for helicopter medevac, many hospitals jumped on the bandwagon to fly.  If cuts are made to Medicare, how will helicopter medevac fair?  Already the industry must be struggling with issues of survival because of high insurance premiums, lawsuits and accidents.

Think about it; are helicopters really cost effective?

 

 

Obesity and helicopter medevac

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.

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.

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.