Medical helicopter industry 'out of control'

[Dustdevil]

http://www.ems1.com/air-medical-transport/articles/815233-Medical-helicopter-industry-out-of-control-conference-told/

May 04, 2010

Medical helicopter industry 'out of control,' conference told

The number of medical helicopters has more than doubled in the past decade, the session was told

By Jamie Thompson

EMS1 Senior Editor

LAS VEGAS — Medical helicopters are an important part of the EMS system but have become "out of control," Fire-Rescue Med was told Monday.

"It's an industry out of control but an industry we need to rein in," Bryan Bledsoe told the conference in Las Vegas.

Dr. Bledsoe, professor of emergency medicine at the University of Nevada School of Medicine, outlined the huge increase in the number of medical helicopters across the United States — as well as HEMS operations — over the past decade during the presentation.

One of the main issues related to air medical safety, Dr. Bledsoe said, relates to the lack of regulation in the United States.

"The helicopter industry can't be touched because it falls under the Airline Deregulation Act, so states cannot really regulate medical helicopters," he said.

The rise in the number of air medical operations in the past 10 years follows a trend over the decades of specific medical industries becoming out of hand, with Dr. Bledsoe citing the "boutique" psychiatric and substance abuse facilities of the 1980s and home health care agencies of the 1990s.

The number of medical helicopters has more than doubled in the past decade, the session was told, and emergency personnel are feeling more pressure to use them — often unnecessarily — as more of them scramble for business.

Dr. Bledsoe outlined the results of several studies that examined the use of air medical transport in both the United States and overseas.

These included a UK study in 1996 of the London Helicopter Emergency Services, which was a prospective comparison of seriously-injured patients transported by HEMS and GEMS.

It concluded "as there is no evidence of any improvement in outcomes overall for the extra cost, HEMS has not been found to be a cost-effective service."

One of the most recent studies, Dr. Bledsoe said, came last year with Helicopter Evacuation of Trauma Victims in Los Angeles: Does it Improve Survival?

Among the conclusions was "in a metropolitan Los Angeles trauma system, EMS helicopter transportation of injured patients does not appear to improve overall adjusted survival after injury. There is, however, a potential benefit for severely injured subgroups of patients due to the shorter prehospital times."

However, while there is a large volume of literature from both sides on the subject, the quality "isn't great," according to Dr. Bledsoe.

But what there is, he told the session, seems to show no or only limited benefit of using air medical transport in many scenarios.

Dr. Bledsoe said in many articles there is a virtual statistical "leap of faith" to justify air medical transports.

[KosherMedic]

Well, I have some comments.

I would like to preface them by saying that I am not even close to being an expert on this subject, so I may require considerable correction.

I recently attended the Critical Care Transport Medical Conference in San Antonio. While I was there I was shocked to hear that our American brothers fly in what I consider unsafe conditions. Many of the medical rotary-wing aircraft are flown by only one pilot and without Night Vision Goggle (NVG) capabilities. Further, the dispatch problems that naturally result from companies that are trying to scoop the flight and make some green when it is too dangerous to fly.

In Canada, I believe that all medevac helicopters that are part of the 911 dispatch system are twin-engine aircraft that have two pilots and NVG capability. I honestly thought that this was the standard of care. I have included links to a few of the organisations that provide this level of care here in Canada so you can get an idea of what I had expected to encounter when I visited the USA.

http://www.ornge.ca/...Operations.aspx

http://stars.ca/bins...asp?cid=3-16-37

[Chief1C]

We're pretty damn rural, but when we only had one for this whole part of the state, it was a spectacle to have it come in. It was used once in a blue moon, and always attracted positive media. Now, we can get any one of eight, and people call them for simple shit.

If only there could be more trauma centers, good ones, evenly spaced from coast to coast.

[Kaisu]

In our neck of the woods helicopters are necessary. That being said, when you can get ETAs within minutes of each other from 3 or 4 different flight companies, it becomes real apparent that there are too many of them. That competition means the pressures on the companies to cut corners are high. Some of the things that I've seen are flight companies hiring anyone with a cert and a pulse. It used to be an honor to be a flight paramedic... the best of the best. Now, its the guys (and girls) that can't hang with fire or even the privates; We've got RNs holding entire schedules hostage because of one snit or another and companies being unwilling to fire them; Shoddy equipment- I know of one chopper that was so bad local people refused to fly it. It was shipped to another operation out of state where it crashed, killing the patient and crew.

Kudos to Bledsoe for being so on target. The man deserves his reputation.

edited to fix a stupid spelling error...

Edited May 5, 2010 by CrapMagnet

[pinkemsprincess]

While I definitely can agree there needs to be some regulation of the medevac industry. I firmly believe they do serve a very relevant purpose.

I have worked in 2 very different EMS service areas that are fortunate enough to utilize flight services and with proper equipment their benefit increases substantially. But as was stated previously, due to the competition from overgrowth in the industry we see less than acceptable employees, aircraft, equipment and overall patient care and the abuse of the system by flying any and everything. So, yes, good job Dr. Bledsoe!

[WolfmanHarris]

In Canada, I believe that all medevac helicopters that are part of the 911 dispatch system are twin-engine aircraft that have two pilots and NVG capability. I honestly thought that this was the standard of care. I have included links to a few of the organisations that provide this level of care here in Canada so you can get an idea of what I had expected to encounter when I visited the USA.

http://www.ornge.ca/...Operations.aspx

http://stars.ca/bins...asp?cid=3-16-37

I don't believe ORNGE has NVG's. They only perform scene responses during daylight. After dark they must land at a lit helipad (usually a Hospital) as part of a modified scene response. Remember though that ~90% of the calls performed by ORNGE is critical care transfers from one facility to another and that the original purpose of air ambulance in Ontario was to serve the extremely remote areas of the North which is where you'll still find the majority of air ambulances.

Edited May 5, 2010 by docharris

[billygoatpete]

Funny that this post pulls me out of lurkerdom.

As usual, I take some issue with Dr. Bledsoe. There seems to be no "grey" area with him on most matters (Pre hospital intubation My link, HEMS, ETC:). The problem I see with this is that he makes generalized statements about an entire industry and, in turn, makes the whole industry look bad.

Has there been a huge increase in the # of HEMS programs in the last 10 years? Absolutely! However, if you look at the majority of those programs, they are privately ran enterprises that approach a hospital and ask " would you like a helicopter based here??" of course the hospital agrees..what do they have to lose?? The program pays the staff, pilots and mechanics..why wouldn't a hospital want a helicopter to call "theirs"? If the hospital says "no" and the program still thinks they can eek their way into the system in the area they simply station it at the nearest airport and PR the hell out of the thing. If it works, great, if not, they pack up and head to the next area they think they can make a profit in.

THAT--IMO is what needs regulated, that type of business plan is dangerous in any industry..but it is super dangerous in the HEMS world. It's pretty hard to maintain a "3 to go 1 to say no" attitude when you know your base is needing numbers to stay afloat. The feeling of competition leads to folks pushing things like weather minimums or trying to take flights that have already been turned down. Additionally, what does the program have invested in it's employees? As said earlier lots of folks want to be flight medics/nurses right? So, in the above business model, why not hire somebody with less experience who will take a lower salary to call themselves a "Flight medic/nurse".

Is regulation needed? Sure it is, we have waaay to many helicopters killing folks. Where does it start though. Even more, where does it end. Dual pilot IFR ships are a great idea, but they are by no means practical in some areas of the US. Do you have any idea what type of AC would be needed to meet that requirement and still be able to function in the altitudes of Alaska, Montana, Colorado or Utah?? Sorry folks, its just not gonna happen.

What Bledsoe fails to look at is that there ARE great HEMS programs out there. Just like there ARE great Paramedics and EMT's out there that need to be looked at as the model for where EMS and HEMS SHOULD be going..rather than breaking down the entire industry to a nice, easy to understand, black and white box.

Again, just my .02¢. Thanks for having me.

[Kiwiology]

We use HEMS mainly because of the isolation of various pockets of New Zealand.

I fully agree that HEMS is overused where it offers no - or little - clinical benefit and (as somebody with substantive aviation experience) I fully agree that the industry needs better regulation.

That said, bloody hell I want one of those orange suits with "DOCTOR" on the back!

[BushyFromOz]

We use HEMS mainly because of the isolation of various pockets of New Zealand.

I fully agree that HEMS is overused where it offers no - or little - clinical benefit and (as somebody with substantive aviation experience) I fully agree that the industry needs better regulation.

That said, bloody hell I want one of those orange suits with "DOCTOR" on the back!

i thought your orange suit said "AUCKLAND PRISON No 101129"

[Richard B the EMT]

As I am rushed a bit today, and do not want to do the research, there was a string in the last 2 or so months, which turned out to be a city member asking instructions on how to set up a HEMS. It seemed to imply just putting medical agency frequencies into the helicopter's radio was all the guy needed.

However, a bunch of us took that poster to task, and basically, we cut him a new one. When it gets to the point of thinking "I got a helicopter with some space inside, so I'm going to start an air rescue/medevac service," I, for one, would agree that there might be too many HEMS out there.