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[BushyFromOz]

LMAO! 8)

Nice to see your cranial seafood bisque is working, as mine is suffering cerebral flatulance obviously! :shock:

[tniuqs]

I love the smell of sarcasm in the morning. It smells like... napalm!

Hey just trying to help out a Noobie is all :shock:

Maybe this Bryan fellow could stop by D. Barns place and get a REAL Avatar.

Why do I sense incoming ? :twisted:

[bbledsoe]

OK. I give up. What is D. Barns? Inside joke? I'm a newbie. Cut me some slack.

[ERDoc]

Welcome Dr. Bledsoe. It is truly an honor to have you here. I was wondering if in your travels you have found there to be a difference in the accident rates between nongovernmental and governmental HEMS. In the system that I started off with, the helicopter program was run by the county police and was staffed with two pilots/POs and a flight medic from the university hospital. Safety was of prime importance. Just curious if you have found this to make a difference.

[Asysin2leads]

Dee Barns, as far as I know is a singer who Dr. Dre (The rapper, not the doctor) slapped once, which is alluded to in Eminem's song "Guilty Conscience", but I don't know what that has to do with anything.

I always consider it an honor when any doctor posts on this board, but especially you, Dr. Bledsoe, welcome. Honestly speaking, my interaction with aeromedicine is fairly limited, as evacs are almost unheard of here in the five boroughs. However, since my unit covers both the east and west side heliports, once in a blue moon we do a stand by and transport the final leg of an aeromedical transport to the appropriate recieving facility, almost all of which come in from New Jersey.

The last transport I did had me scratching my head a little, and your post has shed a little light on it. New Jersey has two nonprofit helicopters run by the State Police, Northstar and Southstar, and they were the ones whom I was expecting to bring in the patient. To my shock, I saw it was a helicopter that had the markings of a private, not-for-profit hospital based ambulance group in New Jersey who I was familiar with. The patient was a 50 y/o female with an intracranial bleed who was intubated and sedated with a flight medic and a flight nurse that was being transferred from a local community hospital in NJ to a specialty surgery hospital in NYC.

Now, having myself having done a great deal of critical care transports from NJ to NYC at one point in my life, one of which in fact was a smilar intracranial bleed, I was at a loss for why they had flown her. In fact, and maybe you or ERDoc or Doczilla who can correct me on this, I was told once that flying someone who had suffered a hemmorhagic stroke or similar brain injury can actually compound the risk of transport due to the changes in air pressure during the flight.

I was unaware of changes in Medicare rules, but after reading your post its starting to make sense, and as usual, I am fairly appalled at what people will do for a buck in this industry.

Me, I've never been a big fan of helicopters in the first place. I mean, if I came up to someone and said "Hey, I got an idea, lets land something with a jet turbine and blades that reach supersonic speeds that is loaded with highly flammable aeronautic grade kerosene into a freeway jampacked with commuters," I'd get some funny looks. Yet some people in this field look for excuses to do just that. Someone should take the roll call from the EMS memorial and see what percentage of deaths of EMS providers involved aeromedical operations. I recall doing a quick scan once and noting that an awful lot of them were popping up.

[OzMedic]

Me, I've never been a big fan of helicopters in the first place.

LOL, did you mean to write that Asys? even funnier if you didn't . I concur with your sentiment, we have lost 6 staff and 3 patients in the last 5 years in my service alone due to helo crashes. Things have changed as far as safety goes but I avoid getting on them at all costs. There is always some other mug busting to get on so I let them do it (having survived an engine-out helo landing I cannot recommend it). Remember the old saying people "Helicopters do not fly, they beat the air into submission" (problem is, sometimes the air fights back!)

[bbledsoe]

I was wondering if in your travels you have found there to be a difference in the accident rates between nongovernmental and governmental HEMS. In the system that I started off with, the helicopter program was run by the county police and was staffed with two pilots/POs and a flight medic from the university hospital. Safety was of prime importance. Just curious if you have found this to make a difference.

The following is somewhat based on evidence and somewhat on experience. In the overall scheme of things, I would have to say that generally the government operated helicopters are safer and probably a better model. There are several reasons here:

1. They can afford bigger aircraft (Dauphins, S-76, Bell 430) and are often dual pilots with full IFR and winch capabilities.

2. There is no pressure to fly since an owner or stock holder is not constantly on them about productivity.

3. They tend to be selective on who they transport and tend to assure that the patient is more likely to benefit from HEMS.

4. Maintenance tends to be better in some cases.

The obvious model is the Maryland State Police. They fly Dauphins and have an excellent safety record. I know there are issues in MD but overall that is a good comprehensive, although expensive, system.

In my travels I have seen this:

1. The Australians come as close as any to doing it right. The states of New South Wales and Victoria operate helicopters and fixed-wing aircraft as a part of their EMS operation. Two years ago I attended a meeting in Sydney where the paramedics on the helicopter were concerned about a particular doctor at an outlying hospital calling them for patients who did not stand to benefit from transport. I have ridden with the HEMS in Melbourne. They are Dauphins operated by the police and staffed with MICA medic. It's a very good system. HEMS in Australia are more for rescue and engress/egress issues. Fixed-wing aircraft are used for moving people around. Remember Oz is as big as the continental US.

2. New Zealand is an absolute mess. There are some good operators such as Westpac in Auckland. But, what is happening in NZ is weird. The people that own helicopters (for whatever reason) set up these "shell" charities in order to write off the costs of the helicopter. They get a tax break by making the helicopter available occasionally for EMS. Most of the helicopters are not staffed. When a call comes in, a crew from St. Johns or the Wellington Free Ambulance go and staff the helicopter (the Westpac helicopter is staffed 24/7). There are alot of fund raising and actually some operators are profiting. When I was down there last year I was asked to meet with Crown authorities trying to get the situation under control.

3. The United Kingdom is alot like New Zealand. There are some full-time helicopters but most are community-supported operations (charities) staffed by ground crews. There are also some operations, such as London, which are physician-staffed but only fly 2-3 times a day (it is hard to land in London). The HEMS throughout the UK are always having fund raisers and certain operations are open or closed depending upon funding.

4. Canada has a reasonable system (there are more medical helicopters in Dallas/Fort Worth than all of Canada). The HEMS in Canada functions as a part of their health care system. They are almost all dual pilot and IFR. The Canadians are certainly doing things better than the Americans in this endeavor.

5. In Europe the HEMS is primarily physician-staffed. Some countries forbid night flights. Rescue seems to be the theme.

The common thread here is:

1. Government seems to belive that the primary role of HEMS is rescue and engress/egress problems.

2. The scientific evidence is pretty clear in that only a small percentage of patients stand to benefit from HEMS transport.

3. Profit is driving the US system hence the increase from 300 to nearly 1,000 medical helicopters in 5 years. I live south of Dallas/Fort Worth approximately a mile from the Midlothian/Waxahachie community airport. Both Bell and American Eurcopter do their new buyer orientation flights at this airport. Every day, and often weekends, there is a new helicopter being tested here. Yesterday it was a BK-117 that said Life Flight. Today is is a Bell 407 with a name I can't read (but a Star of Life).

4. Many of the US operators fly single-engine or small aircraft (Bell 206-L or Bo-105). The vast majority are single pilot and few are IFR. There is a shortage of helicopter pilots in the US. The Vietnam-era pilts are retiring. The military is offereing cash incentives and other measures to keep pilots in the service. Obtaining a helicopter license in the private sector costs tens of thousands of dollars (all for a job that pays $40-60K a year). With the pilot pool in decline and demand onthe increase, it only means that more and more HEMS is being flown by pilots with considerably less xperience.

5. We let the HEMS give us the criteria when to use HEMS. That is like letting Starbucks tell use when and where to drink coffee.

6. We (doctors, nurses and EMS personnel) are part of the problem and can be part of the solution.

That's how I see it. Your mileage my vary.

Bryan

[tniuqs]

OK. I give up. What is D. Barns? Inside joke? I'm a newbie. Cut me some slack.

Well mute point now, as somehow an avatar has popped up, is that significant for some reason a Star of Peace for EMS I am hoping ? I digress. Perhaps we should get back on topic before "the Dean" (thats an inside joke) violate's us for going "off topic".

ER Doc has some very good questions.

Oops, as I type I hear incoming mail, thanks Doc.

cheers

Late Entry: If we EMS personnel are part of the problem then how can we tangibly effect change ?

Just a suggestion, perhaps a review with Topside Medical Directors reevaluating current criteria of the use of rotary?

Query: I suspect a difficult question to answer, when the bird flies does the ground EMS operator reimbursed at the same level? Perhaps the funding "formula" could be reevaluated as well, I know in my "hood" that if the bird flies then a different goverment agency pays and as result of that the Ground service(s) usually billing a private insurance in most cases, this loss of valuable and funding essential in maintaining the ALS operations at a rural level, this has caused much controversy as one might expect. Granted the Vast majority of the medevacs in my country are accomplished by Fixed a completely different ball of wax er vegetable, thoughts from a turnip.

[JPINFV]

Besides the lack of glitz and glamor, is there any reason why the state governments or the FAA doesn't mandate at least instrument flight rules (IFR) for aeromed, if not IFT and forward looking infrared (FLIR). I think that with the recent Mercy Air crash in Riverside, CA that it wouldn't be too hard to get an incitive started out here to require it.

[flight-lp]

First and foremost, Dr. Bledsoe, welcome to the city, its always a pleasure to hear your views associated with misutilization, especially in the over populated regions of Texas. As a Texas flight medic and a Commercial Pilot, I too am greatly saddened by the current state of HEMS. Yes governmental, or even to some extent, hospital based systems are safer and better equipped. They are also usually more effectively managed. The sad part is that most of them are based where they do not need to be, in the urban environment. Inter-metro area critical care transports can and should be transported by ground with appropriately staffed teams. It is the underserved rural areas that truly benefit from HEMS. However, the majority of these rural areas settle for what they can get. For instance, one company in particular (no names mentioned, but Dr. B and Rid can probably figure it out pretty quick) serves only rural areas. But they do so in under powered, single engine, VFR, non GPS, 20-30 year old helicopters with 20,000+ hours on the air frame. In some cases when fully loaded, a ground ambulance is faster than the helicopter! Unfortunately, I believe it is a problem is an irrepairable one until the FAA and NTSB intervene. IFR aircraft or even dual pilot is not the answer, it will just cause further issues and will not decrease the current accident or mortality rate. Allowing pilots to enter actual IMC conditions off of published airways down to ground level (outside of an airport with a published instrument approach) is unsafe, period. Approach controls and ARTCC's do not have the time nor resources to safely track an IFR medical helicopter. Plus, what happens when a pilot goes to shoot an instrument approach into the hospital helipad and finds that he is still in IMC at his minimum descent altitude? He now has to go to an airport, shoot another approach, then wait for an ambulance to arrive to transport. The only true need for HEMS is now lost; TIME............It is the basis of civilian air medical services. Its not about what the crew is or can do, its how much time can they save for the patient. The feds need to get involved. They need to stop the uneeded growth and corporate greed. Fortunately, courtesy of managed healthcare and federal cutbacks, most air medical reimbursements will be reduced if not cut completely off in the near future, thus forcing many services out of business. Just like most things in this world, it ain't what it used to be! I seriously doubt it will get better....