As you can see, I'm not totally against flight transports- there are indeed times when they make perfect sense and do save a life- or at the least allow recovery to begin sooner.

What I am against, is flight transport for cases that don't really need it. I mean, cases where it has no real effect on the outcome other than the price.
These are the ones where I would expect problems with insurance re-imbursement and the ideas I have brought up so far in this discussion.

Personally, for myself, I'm thinking anything that might happen to me that truly required air transport to survive- I probably don't want to survive.
But I'm just an old goat who is a cheapskate and refuses to run with the current american idea of survival in any condition and at any cost.

I guess the biggest issue I have is how many people are in a position in that situation to make an $8,000 to $15,000 decision? Also, I would think the decision of the medical professionals should weigh into the whole thing. If a doctor says we need to get the patient to X to try to save their lives, why do you get an insurance company coming back later to second guess it? Sure she did not make it, but I am assuming the doctor thought the air transport was necessary.

If the husband said hey lets airlift her, then I can see charging him for the trip, but if the doctor said it should happen, then it should be covered.

The issue with that is that some doctors go a bit 'over the top'. Some, because they fear law suits. Some, because they think no expense should be spared to save each and every life- no matter the odds. Some, well, who knows why.
I have been familiar with many doctors over the years. While many are quite cost/benefit conscious, many are rather wasteful.
When it comes to having the doctors be the 'gatekeepers', you'll have a very wide variance in decisions.
Now, I'm not saying i agree with, or even like insurance companies in that position either. But this is a very precarious situation.

Of course, healthcare is indeed a business, and in many ways not much different than auto mechanics. If you don't want your new car alligned [or your apparently healthy colon scoped]- the mechanic doesn't do the job. On the other hand, if you want a total overhaul on your 1984 ford fiesta [or the whole works on your hopelessly failing heart], some mechanic/doctor out there will do it- as long as it's paid for.
A big difference here is, the mechanic can place a lien on or repossess your car. A doctor or hospital does not repossess a body- what the hell would they do with them?

Some of the safety issues are starting to come to a head given the multitude of helicopter EMS accidents this year.

I'm posting a link below to a story hosted on the JEMS.com website written by Bryan Bledsoe, DO. Dr. Bledsoe's extensive biography is available on the website. He is an ardent, outspoken critic AND advocate (is that possible?) of helicopter EMS.

Worth reading are some of the feedback comments attached to this article. One comment talks about the possibility that by implementing all of the suggested safety standards, it will drive every helicopter EMS operator out of business. This underscores why it is impossible to operate a helicopter EMS program on a shoestring budget.

He also talks about how Helicopter EMS subscription plans must be outlawed. We're talking about Air Evac again here, selling memberships. There's no such thing as a guarantee of service and giving people a sense of entitlement that they paid for and therefore DESERVE air medical services under any circumstances is nothing more than a RIP OFF of their money.

As a final note, Dr. Bledsoe refers to one of the possible safety standards being the ability for states to impose stricter regulations than the FAA for air medical operations. Specifically, he mentions Tennessee. This is a case where Air Evac spent loads of money to fight the State of Tennessee AGAINST requiring stricter safety regulations.

Have a gander. Draw your own conclusions:

http://www.jems.com/news_and_articles/columns/Bledsoe/s...edical_industry.html

That was an eye-opener, T.B. I am appalled that such basic standards are not already in place. One responder made a good point about the Bell 206's overall safety record, though, which mirrors what I know about single- vs. twin-engine aircraft in general. Unless an aircraft has the capability to fly and land on one engine, it is pointless to require two; that just makes for more things to go wrong (the cost of complexity). My resolve to refuse HEMS services has only been strengthened.

quote:

Originally posted by T.B., FP-C:
outspoken critic AND advocate (is that possible?) of helicopter EMS.

Well, T.B., I believe you do that. You also appear to be willing to give & take both sides of the story. Fine job.

This article, especially the last item, are dead on with what i have been trying to say.
The doc's must be more judicious in their selection of transport methods. Often, a ground ambulance with trained paramedics, is just as efficacious as otherwise. Flight should be reserved for those cases which have good odds of survival yet can not hold on for the amount of time ground transport will take [which usually isn't as long as many might think!]. Some heart attacks, strokes, and traumas simply can not wait, most can. Some, may go by air, only to wait at the next facility for staff to prepare for whatever procedure[s] are to be performed. Waiting is waiting- no matter where. Also, depending on locale, one might need wait for a flight transport- if a ground transport is ready and waiting, it is probably a good choice.
Then of course, comes the finance, which the article points out well.
Another good point made, is when flight is used simply because someone wants to be quicker, or to have a case moved out of the e.r. now, regardless of acuity- these are a croc- and i'm sure happen all the time.
Even though it helps to keep many in jobs, i have a real problem with the mis-use and over-use of healthcare system[s].

Well Salty, I agree with what you're saying. I will remind you, however, it's always easier to be the "Monday Morning Quarterback" in reviewing these situations. Sometimes a decision has to be made where you can't see into the future with a crystal ball. I guarantee that the docs who make those decisions would sometimes like a second chance to make a better decision about whether to use an air ambulance or not. Trouble is, you don't get a mulligan in the medical field. Sometimes you make a decision and it turns out it was the right one all around, sometimes it goes the other way. That doesn't mean they couldn't be a little more prudent when deciding whether or not to call in the helicopter. It just means that they are the ones who have to go home at night having made the decisions they did.

That's a fine point, mom, and one i'm reminded of occaisionally at work, i might add.
But, sometimes, things are pretty obvious [to me at least] and the maybe-not-necessary higher dollar option is still chosen.
I s'pose some folks are okay with that, thinking that if the dr is happy with the idea then they should be too- this is the way itsometimes oughtta be.
Myself, I'm not willing to pay more money just to be moved out of an er quicker or to make the dr sleep better. What good his his nite of sleep, if i can't sleep over my worries over paying my bill??? I don't really mean to 'slight the dr' here- even though i know that's what it sounds like. Just lookin out for ol' numer 1, again.
Of course, I don't fear death as much as some, or find life quite as precious as many do. Ya know, it's just one of those things that happens to each of us- and we should be better prepared for it than most are. I s'pose my 'philosophy' is kinda like "Why sell the farm, to keep one person surviving?", or maybe "we're not supposed to save 'em all- and besides, it's getting awful crowded on this planet- we can't all stay forever".
While some of this might sound 'funny' to some, if you really think about it, this makes sense.

Stage direction from MacBeth (I believe): "All die."

Yes, James, Indeed.
only nowadays, we get too much choice in the matter of death.
I kinda like the old ways- where we either earn our death, deserve our death, or the damn thing jumps up and bites us in the ass!
not the long, slow, medicated, and clinically managed thing that happens in our time.

I want to have about enough time to blurt out
"Oh shi...."
or once unconciouse, my family to leave me that way.
let me leave with dignity, and of course, a small bill!

T.B.,

I have read your comments and I am impressed with your knowledge of Air Ambulance Services and their procedures. I have a blog at http://www.rushvilletruth.typepad.com/. One of my fellow truth seekers pointed out your posts here and suggested I contact you for further information.

I invite you to read my blogs concerning Air Evac to see what my thoughts are. I also invite you to contact me by e-mail at Rushvilletruth@yahoo.com. I would like to use some of your posts in a future article and to also to ask you some questions concerning Air Evac and Air Ambulance Services as a whole.

quote:

Originally posted by Jim Huston:
That was an eye-opener, T.B. I am appalled that such basic standards are not already in place. One responder made a good point about the Bell 206's overall safety record, though, which mirrors what I know about single- vs. twin-engine aircraft in general. Unless an aircraft has the capability to fly and land on one engine, it is pointless to require two; that just makes for more things to go wrong (the cost of complexity). My resolve to refuse HEMS services has only been strengthened.

Jim,

In all fairness, the Bell 206 is an excellent rotorcraft with a very good safety record. Versatile and produced in large numbers since the late 1960's, it has served in virtually every utility application, executive transport and public safety role worldwide. It is possibly the world's most popular rotorcraft.

However, it was never intended for the zero error margin, high mechanical stress, max power applications of helicopter EMS. That goes for inside and out. It is extremely cramped on the inside, and the patient's legs actually ride up front next to the pilot.

Converting and using a Bell 206 is the wrong application for HEMS and nothing more than a cost-cutting move on the operator's part.

You can put a huge Rolls Royce engine in it, equip it with three crew members who are 150 pounds or less, keep the required minimum fuel and equipment on board and still be potentially at maximum lift capacity with a large patient during the summer months.

Blame the air medical operator, not the aircraft...you wouldn't bring a Yugo to race in the Indianapolis 500, would you?

Heard a rumor from an Air Evac employee today. They said that some corporate muckety mucks are coming to town Wed. with an eye towards possibly closing the base. Seems that there is a letter drive going on to try to keep it open. This should be interesting. I wonder if they are thinking of closing it due to lack of business or for other reasons. I have heard people say they tend to locate for a year or two in an area and then move on. I wonder if that is the case here.

Just peachy - another empty building. At least now we know why they put up the cheapest crap they can get away with.

At least with this one they can put wheels on it and drive it out of town. I really hate to see it fail, but from the start this project had a lack of leadership about it that caused issues.

It came in secretly, operated secretly, when people tried to shine some light on it, they were targeted by the powers that be. They violated Federal, State and local laws and when they needed to, they pressured those tasked with keeping people safe to bend/break the rules to get there way.

I really wish the leadership behind it would have followed the rules.