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"medical" helicopters are noisy, unnecessary, overused, expensive, and unsafeMarch 17 2005 at 6:27 AM
Johnny Bob (Login jbob)
from IP address 188.8.131.52
--There have been 4 fatal crashes so far this year, and this is still only
--Medical helicopter crew/pilots have a 40% chance of dying in a crash after
20 years at 20 hours per week.
[because online newspaper articles disappear, it is copied below...]
Safety record of air ambulance industry under scrutiny
Friday, March 04, 2005
By Kevin Helliker, The Wall Street Journal
For weeks now, federal regulators have been investigating the safety record
of the air-ambulance industry, which has experienced four deadly crashes
But an increasing body of evidence suggests there is a larger question to be
asked about emergency-medical air transports: Do they benefit most patients?
The conventional wisdom is that air ambulances save the lives of patients
who are too critically ill to withstand a slower ride in a ground ambulance.
Yet some observers of the industry say medical air transports actually save
very few lives -- while costing as much as 10 times more than ground
ambulances. A number of published studies including research at Stanford
University and the University of Texas, show that the flights often
transport minimally injured patients when ground transport frequently could
get them to a hospital faster, and with less risk to others.
"In 20 years of experience in urban critical-care helicopter transport, I
can count on the fingers of one hand the number of times I thought flying a
patient to the hospital made a significant difference in outcome compared to
lights and siren," says David Crippen, an associate professor of critical
care and emergency medicine at University of Pittsburgh Medical Center.
Inspired by images of helicopters evacuating wounded soldiers in Vietnam,
the air-ambulance industry took root in the 1970s and has grown steadily
ever since. The industry fleet has nearly doubled since 1997, and patient
transports are rising an estimated 5 percent a year, according to Tom Judge,
president of the Association of Air Medical Services, a trade group.
The current probe of this year's fatal crashes, begun in January, comes as
the industry has drawn increasing scrutiny over not just safety, but also
efficacy and possible overuse. Also in January, the journal Prehospital
Emergency Care published an abstract reporting that a study of 37,500
helicopter-transported patients determined that two of three had only minor
injuries. One of four had injuries too minor to require hospital admission.
"The evidence says too many patients are being flown, and yet they keep
flying more," says Bryan Bledsoe, a physician who co-authored the
Prehospital Emergency Care abstract.
Among other recent research critical of air-transport use, Stanford
University trauma surgeon Clayton Shatney conducted a study of 947 patients
flown to Santa Clara Valley Medical Center and concluded that helicopter
service potentially saved the lives of only nine of them -- while
potentially serving as detriment to five who could have arrived faster by
ground. Travel by helicopter often is slower in urban situations, in part
because of a lack of places to land. "In multicasualty situations, it has
not been uncommon that ground ambulances arrive before an airship with
patients from the same event," says the Stanford study, published in 2002 in
the Journal of Trauma, Injury, Infection and Critical Care.
To be sure, there are situations where there is little debate that medical
air transport has clear benefits, such as in rural areas where patients must
travel long distances quickly. Some smaller hospitals that fly patients to
bigger facilities say they must err on the side of caution with a patient
they aren't equipped to handle themselves. And there is research that shows
a value for patients. A 2002 study, conducted by an air medical service in
Boston compared patients flown with patients driven and showed a 24 percent
survival benefit among the most seriously injured who were flown. "That's an
enormous benefit," says Mr. Judge of the Association of Air Medical
The cost of air ambulances varies -- generally from $5,000 to $10,000 a
trip, and sometimes as much as $25,000, according to industry experts. That
is typically five to 10 times as much as ground ambulance. But ground
transportation also can be not just less expensive, but faster: A 1995 study
of air transport of potential organ donors in Houston, conducted by trauma
surgeon Christine Cocanour, found that 27 of 28 would have arrived faster by
Air-transport industry leaders, including Stephen Thomas, a physician and
associate medical director of Boston MedFlight, an emergency medical
air-transport service, attribute the high rate of minimally injured patients
to the difficulty of conducting accurate injury assessments at the scene of
accidents -- especially considering that such calls often are made not by
physicians but by paramedics and even police.
But the majority of air transports occur not from accident scenes but from
hospitals, according to the Association of Air Medical Services and others.
Frequently, doctors at a smaller hospital assess and stabilize patients
before dispatching them to larger medical centers.
Insurance companies -- which often must pay for the costly transport -- say
they are reluctant to second-guess the decisions of these doctors, who may
view air transport as the least-risky choice for both the patient's health
and the hospital's liability.
Consider the decision on Jan. 11 to fly Ryan Memering out of Memorial
Hospital of Carbon County in Rawlins, Wyo. Mr. Memering had two fractured
vertebrae and a deep gash inside his mouth from a car accident. Doctors at
Carbon County made the decision to fly him to a larger trauma center in
Casper, 120 miles away.
Hospital officials in Rawlins say that ordering the air transport was a
clear-cut decision: Though the 45-bed rural hospital has a small
intensive-care unit, it lacks full-time specialists for higher-level acute
or trauma care. "Any time you have something out of their scope of practice,
that's a liability for anyone. Do you want to take that risk?" asks Candace
Hofmann, the hospital's ambulance director.
The plane dispatched to retrieve Mr. Memering attempted to land in the dark
at Rawlins Municipal Airport. It crashed three miles away, killing three of
four crew members on board. Not until the next day did Mr. Memering get
flown to the Casper hospital, where doctors performed no surgery and
released him in four days. "The staff there said Rawlins had panicked
basically," says Serena Memering, the patient's wife. Her husband, she says,
"feels guilty that three people died because of this. In my opinion, it was
a waste of lives."
The Rawlins crash represented the third fatal accident of an air ambulance
during the first two weeks of 2005, prompting federal regulators to open a
Safety experts say the industry's crash record is less a threat to patients
than to crew members, who if they worked 20 hours a week for 20 years would
face a 40 percent chance of being involved in a fatal crash, according to
Johns Hopkins University epidemiologist Susan Baker, a professor in the
Johns Hopkins Bloomberg School of Public Health who has studied the
industry. Possible outcomes of the federal probe include a requirement that
pilots wear night-vision goggles. The four fatal crashes so far this year of
air ambulances have killed six crew members and one patient.
Patients can end up paying for helicopter transport that wasn't medically
necessary. After 9-year-old Tyler Herman fell and broke his jaw in the wilds
of Arizona, doctors at a community hospital decided the boy should fly to
Phoenix to undergo plastic surgery for a gash on his face. During the flight
he was well enough to sit up and remark on the scenery. Upon arriving in
Phoenix, he waited nearly 20 hours to undergo surgery. "We could have driven
him there in four hours," says Sharon Herman, the boy's mother. Her
insurance didn't cover air transport, leaving the Hermans with a bill for
On its own, the air ambulance doesn't appear to be a huge money maker.
Earnings at the industry's largest player, Air Methods Corp., climbed to
$5.1 million from $3.4 million during the five years ended in 2003. But a
2003 Journal of Trauma study conducted by the University of Michigan Health
System, which runs a flight service, found that flown-in patients had better
insurance and generated significant "downstream revenue" because the
patients developed a relationship with the hospital and often returned years
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