Helicopter usage?

[Just Plain Ruff]

i know that we have discussed this Ad-nauseam but I have been asked a question by someone I respect.

Here is the question:::::

Do the field EMS providers or helicopter EMS providers in the region utilize aeromedical resources inappropritately? How much has the use of helicopters increased since CMS and HCFA began reimbursing for them?

What is this communities thoughts on this question.

[JakeEMTP]

Due to the proximity of the hospital, 25 minutes from the further part of the district in which I am stationed, my partner and I have made use of the helicopter transport once in two years. In that case we had multiple patient's and the extrication of one was going to be in excess of 30 minutes. When we arrived on scene and had completed scene size-up and triage, the decision to call for additional resources including aero transport was made. I should add that the helo service is stationed at the hospital we transport to. There are 3 available, but honestly by the time they lift off, fly to our location, land, are given a report, load the pt then fly back to the hospital, we could be there by ground. Only in extreme cases will we fly anyone from a scene.

When it comes to treating my patient's appropriately and transporting them effectively, the cost of the transport never enters my mind. We do what is best for the patient.

[RavEMTGun]

The literature I've read definitely shows overusage. (Goes to find those articles)

[fireflymedic]

In urban areas, yes I think there is a definite overusage of HEMS - unless you are in excess of 30 min from the scene which is really rare I do not see the neccessity of using them. As previously stated by the time call comes in, lift off, landing, report, take off, transport, landing and transport into ER you could have usually already had your patient in and evaluated.

However, for rural areas that are an excessive distance from a trauma or definitive care facility (yes I'm lumping some medical things in here ie STEMI, suspected CVA, etc) I would rather see a service call for HEMS than sit and wait, the patient wait around then finally get transferred out (usually by air med due to distance and also the oh crap factor of the physician in the ER). Average time for a significantly injured patient from injury to evaluation at a trauma center is around 4-5 hours if diverted to another facility. There's alot of patients that can't wait that long. So yes, I don't mind someone calling based on mechanism of injury due to that. Easier to treat it earlier than later with better chance of recovery.

I think it is entirely dependent on distance, local department's capabilities (and their availability - if they have one medic in the county it changes the position about than if they have one on every truck), mechanism of injury/nature of illness, what the patient's complaints are, and the potential for injury, and current status. If anything makes it high risk, then I wouldn't object to a helicopter being called for transport. If the indications aren't there or within 30 min of evaluation then go on by ground.

[itku2er]

I can only speak for the area I live I don't think we over use them. Here about the only thing we call for a chopper is a trauma. The hospital uses them more than EMS does for flights to places like Holston Valley or Roanoke. We are a rural area and have no major tauma centers, heart centers or the like in the area. So the hospital flies all those out.

[46Young]

This is what my FRD advises us abour Air Medical Transport:

The routine use of Air Medical Transport based SOLELY on mechanism of injury (MOI) should be discouraged.

The decision to transport by air must take into account a number of factors.

1. Logistical factors - access and time/distance variables.

-Proximity to the receiving facility

-Traffic congestion

-Topographical factors limiting patient access by ground or water transport units

-Availability of and proximity to an acceptable landing zone

2. Patient factors

Trauma - MOI significant enough to require transport to a trauma center plus one of the following anatomic/physiologic abnormalities

- Compromised airway, cannot be maintained or managed

-Respiratory distress/failure

-Signs/symptoms of hypoperfusion/shock

-GCS of 10 or less; GCS decreasing two points from 1st and 2nd assessment

-Loss of consciousness more than five minutes

-Neurological signs/symptoms suggestive of spinal cord injury

-Two or more long bone fractures/deformities

Medical/Surgical (suspicion of the following)

-Acute ST elevation MI with S/Sx of shock or severe CHF

-Ruptured AAA (abdominal pain/back pain and hypotension)

-Aortic dissection

-Acute ischemic CVA (stroke) less than 3 hours from symptom onset

Contraindications to Air Medical Transport

-Pt has no obtainable vital signs upon initial assessment and remains without vital signs during the course of the resuscitation effort

-Pt is contaminated with a hazardous material

-Patient's condition requires multiple caregivers and/or space to provide CPR

-Pt size (consideration)

-Patient's injuries (grossly angulated fractures)

[P_Instructor]

Usually inappropriate for scene response. My opinion is that aeromedical (which is typically a money loser except for being a flying billboard) should not be utilized within a 20-30 minute scene from trauma facility. Only under extreme circumstances should it be utilized as stated in prior post (multiple patient, prolong extrication, etc.). This being said because dependant of region, request to liftoff time usually between 8-12 minutes where you still have land/scene/stabilize/package/load/transport/land time which most commonly computes to longer out of hospital time than ground transport. If the ground transport will take longer, then utilize, but it also may be dependant on patient condition (ex. fly a broken ankle????) Every situation will have different perception on utilizing the aero resource.

[Jwade]

In response to the OP question....

ABSOLUTELY HEMS is way over utilized!

Having just finishing up an MBA, I can tell you, I have extensively studied the statistics of everything HEMS.....( 3 Graduate Stats classes will force this).

I have to disagree with the above poster, HEMS can easily be a money-maker dependent upon aircraft type, location, time and distance, etc.....

For example,

Take an A-Star B3 , Single Engine, staffed with 4 pilots, 5 nurses, 5 Paramedics for the base.

Average number of flights to cover fixed costs for the month is 16-20 with average reimbursement in the 10 - 15k range.

Lets take my previous rotor base, Airevac 9, We would average 60 flights month.

60 * 15k = 900,000 dollars gross

subtract your 20 flights to cover fixed costs, ( Salaries, DOC,etc...)

leaves you with avg of 40 flights @ 10-15k.

this will leave you with a net income of 400,000 - 600,000 dollars a month.....NOW, you throw up 10 more bases on every street corner like there is in Arizona, and do the simple math......You tell me if it loses money or not..... ( NOT)

Why do you think the amount of helicopters has quintupled in the last 7 years? This would not happen if there were not money to be made.....

Again, each company will be different based on aircraft, reimbursement rates etc......

Arizona is by FAR the worst offender of flying patients who have no business being flown.....Many of the ground crews do not want to make the drive into Phoenix, especially during rush hour, so they just say fly them out, regardless of appropriate........This is one of the main reasons I left Rotor wing and went to Graduate School.....

having moved to AZ from Michigan, where there is such strict criteria for using a helicopter was a huge shock to me.....In all my time working the ground in Southeastern Michigan, I called for a helicopter twice......Once for a 95% burn patient who was 45 min from ANY hospital, and the other was a very prolonged ICE rescue from Lake huron.

We were expected to take care of our patients, and not punt them off to the quickest taxi ride available......It is just absolutely asanine out here in AZ.....There are over 25 helicopters in the METRO phoenix area.......Do you really think there are that many patients who need Air Transport?

The studies prove >75% of the patients who are flown DO NOT need HEMS......75% you tell me what is wrong with this picture!!!!!!

From this proliferation has come a detriment to the HEMS provider, the talent pool has been watered down to nothing more than a BP and a pair of boots, and a license.......Back in the day, one would have to have a minimum of 10 years experience, instructor status in everything known to man, someone would have to die in the flight program or retire for a spot to open up......and then you would pray you had an inside friend to make a recommendation for you.....

Respectfully,

JW

[chbare]

It's variable by area. Arizona is a mess as stated. In my area, EMS calling us is not so much a problem. However, facilities flying non-urgent cases such as a non complicated ortho case when their ortho doc does not feel like being on call and flying a person to a medical/surgical floor at a larger facility to have their gallbladder removed. The list continues and becomes more obscure; however, the point should be clear.

Clearly, this is not the best resource utilization and quite costly. However, as stated, the bottom line in this business revolves around money. I suspect a great number of us would be in the employment line if HEMS was a properly utilized resource.

Take care,

chbare.

[RavEMTGun]

Found the studies:

http://www.ncbi.nlm.nih.gov/pubmed/16766969

CONCLUSIONS: The majority of trauma patients transported from the scene by helicopter have nonlife-threatening injuries. Efforts to more accurately identify those patients who would benefit most from helicopter transport from the accident scene to the trauma center are needed to reduce helicopter overutilization.

http://www.ncbi.nlm.nih.gov/pubmed/15674165

CONCLUSION: Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.

http://journals.lww.com/jtrauma/Abstract/2004/01000/Effective_Use_of_the_Air_Ambulance_for_Pediatric.15.aspx

Conclusion : Retrospective analysis was not able to demonstrate any benefit to direct transport from the scene to a trauma center. Hospital stabilization before transfer by air ambulance may improve survival and shorten ICU stays for patients with major trauma.

http://journals.lww.com/jtrauma/Abstract/1998/07000/A_Critical_Analysis_of_On_Scene_Helicopter.29.aspx

Results: Patients transported by helicopter were significantly (p < 0.01) younger, were more seriously injured, and had lower blood pressure. They were also more likely to be male and to have systolic blood pressure < 90 mm Hg. Logistic regression analysis revealed that when adjusting for other risk factors, transportation by helicopter did not affect the estimated odds of survival.

Conclusion: A reappraisal of the cost-effectiveness of helicopter triage and transport criteria, when access to ground ALS squads is available, may be warranted.

http://www.ncbi.nlm.nih.gov/pubmed/12169944

CONCLUSION: The majority of pediatric trauma patients transported by helicopter in our study sustained minor injuries. A revised policy to better identify pediatric patients who might benefit from helicopter transport appears to be warranted.