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HEMS - Regulations and saving life

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HEMS - Regulations and saving life

Old 27th Feb 2005, 20:57
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SASless: Yes, yes, yes, and yes. Actually, it's written into our Ops Manual.
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Old 27th Feb 2005, 21:32
  #242 (permalink)  
 
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How about the other outfits GLS....

What limits does your outfit publish? Does it enforce those policies or is there a blind eye turned towards those who fly beyond that particular set of rules?

Do you agree with my view of the Coast Guard and their general unpreparedness for deep water SAR on a timely basis? If you fly out towards the very southern reaches of the the American side of the GOM....do you have USCG SAR available to you for the entire route or do you have to rely upon commerical non-SAR aircraft to come find you and maybe drop a raft to you? Any hoist equipped civilian SAR aircraft in the GOM that you know of?
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Old 28th Feb 2005, 00:55
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The limits are somewhat flexible, but realistic, and enforced. As for USCG SAR, it is somewhat depressing. They will eventually get there, I think, but they are slow. They do have hoists in their cute little Dolphin helicopters. ;-) They don't have a lot of range, but they can refuel on any of the fuel platforms, and often do. My only real complaint is that it seems to take them a rather long time to get started.
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Old 28th Feb 2005, 22:37
  #244 (permalink)  
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NY Times Article

Fatal Crashes Provoke Debate on Safety of Sky Ambulances
By BARRY MEIER


On a mild afternoon last week, emergency workers raced up to Jana Austin's
rural Arkansas home to ask if a medical helicopter could land on her
property to transport a victim of a car crash to a nearby hospital. Ms.
Austin, a nursing student, said she readily agreed, and along with her
4-year-old daughter, she watched spellbound as the chopper landed.

But soon after it took off, the helicopter began to spin, slowly at first,
then faster, until it twirled out of control into a nearby pasture. The
patient died, and the three crew members were seriously hurt.

The accident, whose cause is under investigation, was hardly isolated. In
January, a medical helicopter plunged into the Potomac River in Washington,
killing the pilot and a paramedic. In less than two months this year, four
people have died in four accidents. Last year was a particularly deadly one
for flight crews and patients, with 18 people killed in 11 accidents, the
highest number of deaths in a year in more than a decade, according to
federal regulators and an industry group.

The spike is putting a spotlight on a little-regulated and fast-growing
sector of health care: the medical helicopter industry. There are an
estimated 700 medical helicopters operating nationally, about twice the
number flying a decade ago.

Medical helicopters were once nearly all affiliated with hospitals. But more
generous federal reimbursements and changes in payment methods have
attracted more operators, including publicly traded corporations and smaller
concerns that in some cases set up outposts and market their services to
rural emergency units and even homeowners.

Emergency medical helicopters do save lives, by speeding some patients to
hospitals far faster than a ground ambulance could and by reaching remote
areas. But the industry's rapid, competitive growth may also be exacting a
toll. Federal regulators and some doctors worry that the pool of skilled
helicopter pilots has become drained and that some of those flying are
making poor decisions. In addition, some companies are flying older
helicopters that lack the instruments needed to help pilots navigate safely.
Of the 27 fatal medical helicopter accidents that occurred between 1998 and
2004, 21 were at night and often in bad weather, according to federal
statistics.

"You need to raise the bar and say this is where the bar is," said Dr. Scott
Zietlow, the medical director for the helicopter program at the Mayo Clinic.
"If you can't get over it, you can't fly."

Last month, the Federal Aviation Administration, after a meeting with
helicopter operators, proposed steps to improve flight safety. They included
helping pilots assess risks and providing them with up-to-date electronic
equipment.

Separately, the National Transportation Safety Board has been examining
medical helicopter safety and plans to issue recommendations to the Federal
Aviation Administration, a safety board official said.

Initial reviews by the aviation agency and the safety board indicate that
pilot error was to blame in many of the recent accidents. A report in 1988
by the board, which came after a string of accidents in the preceding years,
found that medical helicopters were crashing at a rate three times higher
than that of other helicopters. At that time, the safety board made a number
of recommendations adopted by the aviation agency, including better pilot
training, particularly for flying in bad weather.

Executives of medical helicopter companies and trade groups said they were
greatly concerned by the rising accident numbers but added that the figures
might simply reflect the fact that more helicopters were flying, rather than
an increase in the accident rate.

The executives said they could not be sure a trend existed because the
industry had been operating without a system to track its total flight
hours, a standard measure for assessing air deaths.

Under pressure from regulators, company officials say they hope to have such
a database in place by late spring, and several asserted that they were not
pressuring pilots to take on dangerous missions.

"We are seeing the number of accidents creeping up, and we need to be able
to understand what the factors are," said Tom Judge, executive director of
Lifeflight of Maine, owned by two health care systems there.

The growing concerns about medical helicopter safety are unfolding alongside
a long-running debate over whether many such flights are medically
necessary. The cost of a medical airlift typically ranges from $5,000 to
$8,000, five times or more than that of a traditional ambulance. Private
health plans and some public ones, like Medicare, cover air services, at
least in part.

There are about 350,000 medical helicopter flights annually, with about 30
percent involving calls to accidents or other emergencies, according to the
Association of Air Medical Services, a trade group in Alexandria, Va. Most
other flights involve the transfer of patients between hospitals.

As recently as a decade ago, medical helicopters were generally operated
directly by hospitals and emergency service units or run under arrangements
with aviation companies, including publicly traded ones like the Air Methods
Corporation and Petroleum Helicopters Inc., which provided the helicopters
and pilots.

But industry officials said the business began to change in the late 1990's
when the federal government required hospitals to charge separately for
ambulance services, including airborne ones, rather than bundling such costs
in bills paid by all patients. In addition, Medicare, in adopting a national
fee schedule, increased reimbursement rates for air ambulance flights in
some regions.

As a result, many hospitals decided to abandon their helicopter operations,
and for-profit companies saw an opportunity.

Mr. Judge, the Maine official, said studies showed that 20 percent of
patients transported by air might have died from injuries or illnesses had
they not been flown.

But Dr. Bryan E. Bledsoe, a former emergency room doctor who lives in
Midlothian, Tex., a suburb of Dallas, said 14 medical helicopters operated
within a 75-mile radius of his home.

"The problem is that there is not that much of a need," said Dr. Bledsoe, a
critic of the air-ambulance industry.

Another significant area of industry growth involves companies that are not
connected to hospitals but instead set up helicopter bases in rural areas
and then market their services to local hospitals, emergency officials and,
at times, homeowners.

For example, Air Evac Lifeteam, which started 20 years ago with a single
base in West Plains, Mo., now has 43 sites in 10 central states. For $50 a
household, homeowners receive a company membership guaranteeing that Air
Evac Lifeteam will not seek additional payment from them beyond what an
insurer will pay. Over 150,000 households are signed up, Air Evac executives
said.

The splintering in the way the industry operates has led to a hodgepodge of
standards. For example, the Mayo Clinic, which gets its craft and crews from
an aviation company, requires pilots to have 5,000 hours of experience and
uses only twin-engine helicopters. Air Evac requires pilots to have 1,500
hours of flight time before hiring them and uses older single-engine craft.

"There is a wide variation in self-imposed standards," said Mr. Judge, who
is also president of the industry's trade group.

The Arkansas accident a week ago involved an Air Evac Lifeteam helicopter
that had just been refurbished after spending 20 years ferrying workers and
supplies to oil rigs. Colin Collins, the company's president, says that it
uses only Bell model 206 helicopters like the one that crashed in Arkansas
because they have an excellent safety record and are relatively simple to
maintain.

Local emergency officials said that the Arkansas car-crash victim, Robert
Arneson, 71 of Harlingen, Tex., had a gash on his forehead but was stable
and alert when brought by ambulance to a field for helicopter transfer.

It was about 20 air miles, or a seven-minute flight, from the crash site, a
trip that would have taken about 45 minutes by ground. But because emergency
workers had to locate a landing area and get Ms. Austin's permission to let
the helicopter land on her property, nearly an hour elapsed, officials said,
after the first emergency call and before the helicopter took off.


Mr. Collins said he expected the National Transportation Safety Board to
release its preliminary findings as early as tomorrow.


In recent months, Air Evac Lifeteam has had two fatal crashes. Other
companies have also had troubles. In January, Air Methods, the industry's
biggest operator, had two fatal crashes within one week, including the one
in Washington. Both operators said those incidents involved their first
deaths in many years.

Even company executives acknowledge that the industry's rapid growth may be
outpacing the pool of experienced pilots.

Mr. Collins said most of his pilots a decade ago were Vietnam veterans, but
the majority have retired, and fliers coming out of the military now are not
interested in helicopters.

While company executives said pilots were not being pushed to fly, industry
critics and federal regulators are concerned about whether pilots are making
the right judgments or have the right information and equipment to base them
on.

Last summer, emergency officials in South Carolina summoned a helicopter to
transport a woman found seriously injured beside a highway. But the first
helicopter, which was based in Columbia, S.C., about 50 miles southeast of
the accident, aborted its mission four minutes after takeoff with the pilot
citing fog and deteriorating weather conditions.

The next two helicopter crews contacted also refused to fly, citing the
weather. Officials called a fourth helicopter, in Spartanburg, S.C., which
agreed to fly, arriving about an hour after the accident. The helicopter,
which was owned by the Med-Trans Corporation, picked up the victim and
crashed shortly after takeoff in a nearby national forest. All four people
aboard were killed.

The South Carolina crash remains under investigation by the National Safety
Transportation Board, and Jeffrey B. Guzzetti, its deputy director for
flight safety operations, said the agency was reviewing the pilot's decision
to fly.

Reid Vogel, a spokesman for MedTrans, based in Bismarck, N.D., said the
company could not comment on the accident because of the federal
investigation. But Mr. Vogel said the company's flight team had thoroughly
checked the weather that day.

In last month's notice, the Federal Aviation Administration, citing the
industry's rapid growth and an "unacceptable" number of accidents, suggested
that operators increase the use of technical aids like radar altimeters,
night-vision goggles and terrain awareness warning systems, among other
things.

In addition, it recommended that companies emphasize a "safety culture" and
also improve systems that will give pilots better information about changing
weather conditions while they are in flight.

"In essence, this is a first step in looking at ways to improve operations
and reduce the number of accidents in helicopter emergency services," said
James Ballough, director of flight standards service at the Federal Aviation
Administration.

Stephanie Saul contributed reporting for this article.
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Old 1st Mar 2005, 00:39
  #245 (permalink)  
 
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Greenville, South Carolina CBS Station Video

Excellent video of crashed EMS helicopters....


http://www.cbsnews.com/sections/i_vi...3420&title=Air$@$Ambulance$@$Risks&hitboxMLC=eveningnews
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Old 3rd Mar 2005, 21:26
  #246 (permalink)  
 
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Latest AEL EMS crash in a Jetranger

NTSB Identification: DFW05FA073
Nonscheduled 14 CFR Part 135: Air Taxi & Commuter
Accident occurred Monday, February 21, 2005 in Gentry, AR
Aircraft: Bell 206-L1, registration: N5734M
Injuries: 1 Fatal, 3 Serious.

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed.

On February 21, 2005, at 1339 central standard time, a Bell 206-L1 single-engine helicopter, N5734M, operated by Air Evac Lifeteam was substantially damaged shortly after takeoff when it made a hard landing in a field near Gentry, Arkansas. The commercial pilot, the flight nurse, and the paramedic were seriously injured and the patient was fatally injured. The helicopter was registered to Air Evac Leasing Corporation, West Plains, Missouri. A company visual flight rules (VFR) flight plan was filed for the flight that departed about 1337, and was destined for Springdale, Arkansas. Visual meteorological conditions prevailed for the medevac flight conducted under 14 Code of Federal Regulations Part 135.

According to Arkansas State Police reports, the patient was involved in a single vehicle, rollover traffic accident. The patient was bleeding from the ear and was combative. An Air Evac Lifeteam helicopter was dispatched to the scene to pick-up the patient and transport him to a hospital in Springdale, Arkansas. The patient was transported via ambulance approximately one-half mile south of where the vehicle accident occurred to a designated landing zone, where he was loaded on to the helicopter. The landing zone was the front lawn of a private residence.

An Arkansas State Trooper escorted the ambulance and reported that he observed the helicopter circle over the accident site, then make an approach to the north and land. The patient was then transferred over to the flight crew and loaded on to the helicopter. The Trooper observed the helicopter as it departed. He said he heard the helicopter's engine achieve full power and then it began a vertical climb to approximately 100 feet, when it began to spin. The helicopter continued to spin, before it got "silent' and dropped to the ground in a field adjacent to the landing zone.

Several emergency medical service (EMS) personnel also observed the helicopter as it departed. Each reported similar accounts of how the helicopter started to spin shortly after it departed, and subsequently land in the field.

A witness, who owned the property where the helicopter had landed, was in her backyard when she observed the helicopter depart. She said the helicopter was initially parked in her front yard facing the north. As it departed, the helicopter ascended and then began to slowly spin to the right as it maneuvered over her house and toward an open field adjacent to her home. She said the helicopter began to spin faster, and after it made several rotations it "dropped" and landed upright in the field. The witness could not recall how high the helicopter was above the ground when it started to spin, but she felt that it was too low. She also stated that she did not hear any unusual noises from the helicopter during its short flight.

The pilot was interviewed in the hospital the day after the accident. He stated that during his recon of the landing zone, he could not find any indicators that would assist him with determining wind direction; however, when he had reviewed the weather that morning the winds were reported out of the north between 330 and 030 degrees and were "brisk", about 10-15 knots. The pilot was also able to identify and verify all obstacles reported by his crew in the vicinity of the designated landing zone.

After the patient was boarded, the pilot said that he brought the helicopter to a hover and noted that his engine torque was near 100 percent. While still in a hover, the pilot maneuvered the helicopter to the right and stopped when he was within 20-25 feet of the property owner's home. He did this so he could avoid the approximately 60-foot-high power lines that ran diagonally in front of the helicopter from southwest to northeast. There was also a set of power lines that ran north/south behind the property owner's home. Both sets of power lines converged at the same wooden utility pole, which was located north of the home.

The pilot stated that when he departed, he began a vertical ascent but was trying not to increase the collective above the available torque. He said that he was concerned about clearing the power lines and losing effectiveness of the tail rotor. When the helicopter reached an altitude that was slightly below the power lines, it began an uninitiated turn to the right. The pilot had full left torque pedal applied at the time, and said that he attempted to gain forward airspeed, and also used the cyclic to follow the nose of the aircraft in an attempt to fly out of the turn. The pilot was unable to gain airspeed, and the helicopter began to spin to the right and descend. The pilot stated that his only option was to initiate an autoration, so he lowered the collective and placed the throttle in the idle position, which slowed the spinning. When the helicopter was approximately 10-20 feet above the ground, the pilot placed the collective to the full-up position to cushion the landing; however, there was not sufficient main rotor rpm to stop the high rate of descent. After the impact, the pilot said the engine was still running so he secured the helicopter, which included turning off the fuel valve and battery switch.

The helicopter came to rest upright in a grass field approximately 100 yards southeast from where it had departed on a heading of 172 degrees at an elevation of approximately 1,000 feet mean sea level (msl). Both skids were spread their maximum distance, and the belly of the helicopter was laying flat on the ground. The aft skid cross-tube had pushed up into the belly of the aircraft and ruptured the fuel tanks. According to the Arkansas State Trooper, approximately two inches of jet fuel surrounded the helicopter shortly after the accident.

The pilot held a commercial certificate for rotorcraft-helicopter, instrument helicopter, and airplane single-engine land. He was also a certified airframe power plant mechanic. The pilot reported a total of 3,500 hours of total flight time, of which approximately 3,438 hours were in helicopters and 15 hours were in make and model.

His last second class FAA medical was issued on December 13, 2004.

Weather reported at Smith Airport (SLG), Siloam Springs, Arkansas, approximately 10 miles southeast of the accident site, at 1335, included wind from 050 degrees at 7 knots, visibility 10 statute miles, clear skies, temperature 61 degrees Fahrenheit, dewpoint 46 degrees Fahrenheit, and a barometric pressure setting of 30.01 inches of Mercury.
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Old 3rd Mar 2005, 22:32
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Let me guess, 3,423 hrs in piston types and this was the first job after leaving the teaching environment........
Let's see if we can connect this thread with the other one where a shortage of specifically experienced pilots is reported?

It would be nice to be able to check the amount of fuel carried and to weight all people aboard so as to get a total a/c weight.
Luckily for him the rear (main) tank ruptured, and double luckily it did not ignite the fuel.
Oh! There I go again, playing Monday Night football coach

At least he recognized LTE and used the correct technique
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Old 4th Mar 2005, 11:14
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Taken from the Wall Street Journal....


Air Ambulances Are Under Fire
Critics Say Emergency Medical Helicopters
Are Overused and Offer Few Benefits to Patients

By KEVIN HELLIKER and VANESSA FUHRMANS
Staff Reporters of THE WALL STREET JOURNAL
March 3, 2005; Page D1

For weeks now, federal regulators have been investigating the safety record of the air-ambulance industry, which has experienced four deadly crashes this year.

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.

Some research on medical air transports:

• A 2002 paper showed a 24% reduction in mortality for seriously injured patients, but nearly 60% of patients actually had lesser injuries.

• A 1995 study of potential organ donors flown by transport found that an estimated 27 out of 28 would have arrived faster by ground ambulance.


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% 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.

Critics say air ambulances are overused and offer few benefits to patients


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% survival benefit among the most seriously injured who were flown. "That's an enormous benefit," says Mr. Judge of the Association of Air Medical Services.

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 ground ambulance.

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 probe.

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% 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 $25,000.

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 later.
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Old 19th Mar 2005, 01:39
  #249 (permalink)  
 
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EMS Article interesting read

BehindTheMedspeak: Medical Helicopters Crash Too Often


Kevin Helliker and Vanessa Fuhrmans wrote a great investigative piece for the March 3 Wall Street Journal on the recent spate of emergency medical helicopter crashes.

Long story short: more often than not an old-fashioned ambulance, with its sirens and flashers and all, makes the trip faster than a helicopter would.

In fact, a Stanford University study published in 2002 noted, "In multicasualty situations, it has not been uncommon that ground ambulances arrive before an airship with patients from the same event."

Not only do helicopters crash far too often (so far this year, there have been four fatal crashes, killing six crew members and one patient), they cost a fortune.

A helicopter ambulance evacuation generally costs from $5,000 to $10,000 a trip, and sometimes up to $25,000, according to industry experts quoted in the Wall Street Journal story.

That is typically five to ten times as much as a ground ambulance.

A 1995 study of air transport of potential organ donors in Houston, conducted by trauma surgeon Christine Cocanour, found that 27 out of 28 would have arrived faster by ground ambulance.

I remember back when I was working at the University of Virginia Medical Center and the powers-that-be decided that they needed a helicopter to be "big-time."

Everyone got all excited about how great it would be, having the ability to fly to Tennessee and West Virginia and bring patients to UVA Hospital.

All I saw was major money out the window and even less sleep than I was already getting when I was on night call, taking care of people who could be just as well and probably better treated in Tennessee and West Virginia.

I mean, they have big-time tertiary care hospitals too.

Nice to know I had the right idea, even back then.

As Bob Dylan wrote, "You don't need a weatherman to know which way the wind blows."

Here's the story.

Air Ambulances Are Under Fire
Critics Say Emergency Medical Helicopters Are Overused and Offer Few Benefits to Patients

For weeks now, federal regulators have been investigating the safety record of the air-ambulance industry, which has experienced four deadly crashes this year.

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% 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.

Critics say air ambulances are overused and offer few benefits to patients

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% survival benefit among the most seriously injured who were flown.

"That's an enormous benefit," says Mr. Judge of the Association of Air Medical Services.

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 ground ambulance.

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 probe.

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% 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 $25,000.

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 later.
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Old 19th Mar 2005, 13:44
  #250 (permalink)  
 
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In my short time in EMS, more than once we have been not only first on the scene, but first on scene by a margin of nearly half an hour. The ground ambulance ride back to the nearest small, rural hospital is another story altogether - one example was a 2 hour ground ride to a hospital that could do little for the patient, compared to a 25 minute ride to a well equipped regional truama center.
The study, like all studies needs to have the parameters identified. In cities and urban areas, there is probably a good case to be made that helicopters aren't much faster.
Out in the sticks - there is no comparison.
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Old 20th Mar 2005, 01:46
  #251 (permalink)  
 
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Ah, the voices of vested interests. Me too!

I wonder if the quoted expert on spinal trauma, Mr Memering and his lovely wife, were at the accident scene going:

"I'm fine, dont worry about the risks to my spine, I'll be right. In fact, my wife could drive me to the other hospital 120 miles away, no probs. I mean driving is extremly safe, especially since I have just had a car accident. Don't waste the money on my spine boys, warm up the car will you darling whilst I clean up this cut on my face?"

Oh and this gem:
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
Those nine were worth how much? Oh that's right Clayton Shatney, they were not your children were they? Just as well, so we can be assured that your excellent study is purely objective.

I am not saying that medical air transport should grow out of control, or that it is some how above being reviewed, but I am amazed at the amount of "experts" willing to comment and pass such far reaching judgements. One day, I am going to do a study on trauma medicine centres (because I have flown EMS I am clearly an expert) which will probably shed light on the 100,000 or so deaths that occur in the USA Hospital system each year due to human factors failings. The study will show that if trauma medical experts studied human factors, CRM, decision making, and team management INSTEAD OF the 947 patients that their fellow workers elected to fly in the field, at the heat of the moment, THEN maybe there would be an outcome that benefited thousands of lives instead of 5.

Or thay could just listen to us because all aircrew are experts on all subjects. Just ask us!
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Old 20th Mar 2005, 15:07
  #252 (permalink)  
 
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REGA's Record?

Does REGA have the same problems as US operators? I would guess not. They also do high-altitude hoisting. Perhaps they should be studied for their Best Practices.
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Old 22nd Mar 2005, 01:50
  #253 (permalink)  
 
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If you'll permit me...
On the EMS provider point of view (coming from quite a few years in the EMS industry), I've been saying that at least in the area I'm in, far too many patients are flown that could safely be transported by ground ambulance. The main problem comes from several things...
One, you have some 16 year old EMT who thinks it'll be "cool" to have a helicopter come out to HIM.
Two, you have poorly trained EMS providers, with very restrictive medical protocols, who panic at the sight of a potentially complicated patient, and call for the helicopter, because the flight crews MUST know more than him/her.
Three, as the article stated, you have large tertiary care facilities who want to look more impressive with a flying billboard, and who will send it for patients who are even a short distance away, because they want to have "The Look".

It's a problem of perception in the EMS community, which will not go away without a thorough, detailed process of education for EMS providers on what a helicopter or fixed wing can or cannot provide, and a better risk/benefit analysis for all people involved.
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Old 22nd Mar 2005, 02:22
  #254 (permalink)  
 
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I think that a lot of the unnecessary calls are a direct result of the US problem of "Sue the Bastards!". The medics at the scene are under a lot of pressure to make sure that the correct transport decision is made. Woe to the agency that elects to ground transport a possible C-spine or internal injury only to find out that they increased the severity of the injury or that the patient expired when a "higher level of care" or a "more rapid mode of transport" was available. Also, I doubt that the study took into consideration which hospital was on bypass. I wonder if they ever looked into the patients that were not transported by air and the outcome of those patients.
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Old 22nd Mar 2005, 09:33
  #255 (permalink)  
 
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One can feel the heat of the flames of this subject over here in UK. As an outsider in this topic I do realy feel that as quoted above those on the ground at the scane have to make a decision with vision that is less than those who after the event are blessed with perfect vision. This idea brings to mind the training and equipment at the disposal of the EMS crews. I would have to expect not only a suitable twin engined helicopter but also that the crew is fully trained in the use of NVG and have an IR and know every landing site that is likely to be used. The latter is an almost impossibility due to likelihood of the pick-up location being virtually anywhere though hospital sites should provide no problems. The final decision should rest with the crew who should have very tight guidelines encompassing such limits as weather and location unfamiliarity. The stupid American logic of 'Sue the Bastards' is an inherent problem which has grown up within the 'Gun Ho' attitude of the American brain.
A better logic would be the health and safety of the crew being balanced by the benefit of patient rescue.
Interesting to see that An AS350 was used to take a patient flying in Canada. Single engine in possibly urban area, oh no!
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Old 24th Mar 2005, 12:40
  #256 (permalink)  
 
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An interesting account on "competition" as seen by a hospital based operation at Duke Medical Center in Durham, North Carolina.


WakeMed Wants Its Own Air-Ambulance Program Like Duke

POSTED: 12:28 pm EST March 13, 2005
UPDATED: 12:32 pm EST March 13, 2005

DURHAM, N.C. -- A struggle for air power is swirling between two Triangle hospitals – Duke University Health System and Wake Medical Center. Duke's Life Flight air-ambulance program is celebrating 20 years of service, while WakeMed is fighting to fly its own program.

When a deadly wreck shut down I-40 in Cary last October, Life Flight raced to the scene from Durham. That's because hospitals in Wake County are grounded.

“My reaction was ‘Pardon me? There’s no helicopter service here?’” said Dick Sears, the Holly Springs mayor.

Sears is leading an effort by the Wake County Mayors' Association to change state law, which prohibits two air-ambulance services within 60 miles of each other.

“Times have changed,” Bill Atkinson, the WakeMed CEO, said. “The laws that we're dealing with are twenty-five years old and have not been modified in that time."

When Duke started flying, air ambulances were a risk. Now business is booming, and WakeMed wants in on the action.

Jeff Doucette, Life Flight's associate director, said the law not only protects Duke, but more importantly protects the public.

“What we're seeing in trends throughout the country is that in states that don't have laws like North Carolina,” Doucette said, “third party operators are popping up all over the place."

These operators, Doucette said, play by a different set of rules.

"For-profit entities that are listening to scanner traffic and responding to accidents are doing things in this business we would consider to be unethical and unsafe," he said.

For now, Duke and UNC, which was grandfathered in, have the Triangle skies to themselves.

Duke’s helicopters make 1,200 flights a year at a cost of $4,500 a flight.

Last edited by SASless; 24th Mar 2005 at 12:55.
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Old 27th Mar 2005, 00:59
  #257 (permalink)  
 
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This is a link to the AAMS President's latest letter....which suggests the industry is taking another hard look at safety.


It is rumoured a "Zero Accidents" concept was brought up at the recent AAMS meeting. Maybe someone that attended that could provide more information on that proposal if it is true.


http://www.aams.org/prescorner.html
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Old 1st Apr 2005, 19:04
  #258 (permalink)  
 
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Analysis of EMS Fatal Crashes by a Lawyer

This paper was written by an attorney and looks at the causes and history of the US EMS industry in correcting known problems. Does not seem like much change over the years....

http://www.slackdavis.com/pdfs/AirAmbul.pdf
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Old 1st Jul 2005, 01:59
  #259 (permalink)  
 
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Another Fatal EMS Crash in the USA

Medical helicopter crashes near Durango
Source: KRQE News 13



NEAR DURANGO, Colo. -- A medical helicopter has crashed in southern Colorado, near Durango. Early reports indicate three people were killed in the crash which occurred near about 15 miles east of Durango in the county of Montezuma.
The helicopter had departed from Mercey Hospital in Durango. The chopper was operated by Tri-State CareFlight out of Bullhead Arizona and usually caries a crew of three.

The helicopter was on the way to a logging accident in the area.

Concern network message

Sent: Thursday, June 30, 2005 6:28 PM
To: CN-Bulletin
Subject: Tri-State CareFlight - Fatal accident

DATE
6/30/2005 1259 MDT

PROGRAM
Tri-State CareFlight

VENDOR
Own Part 135

ADDRESS
2755 Silver Creek Rd. #205
Bullhead City, AZ 86442

WEATHER
Clear. Not a factor

AIRCRAFT_TYPE
Agusta A 119 Koala

TAIL#
N 403CF

TEAM
Pilot, Flight Nurse, Flight Paramedic. Fatal injuries. No
patient.

DESCRIPTION
Tri-State CareFlight 4, based at Mercy Medical Center in
Durango,
Colorado, responding to the scene of an injured logger in the
Mancos,
Colorado area, was reported down approximately fifteen minutes
into
the flight. The entire crew was killed in the crash.

No other details are available at this time.

SOURCE
Matt Riley, Director of Operations

VIA
David Kearns, CONCERN Coordinator
=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=

The CONCERN network shares verified information to alert medical
transport programs when an accident / incident has occurred.
Please share the above information with your program staff. If
you have further questions, please contact the CONCERN Coordinator,
David Kearns at 800 525 3712 or email: [email protected].

Last edited by SASless; 1st Jul 2005 at 15:14.
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Old 1st Jul 2005, 22:48
  #260 (permalink)  
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Sasless.
I know nothing of the terrain, but given that the USA is so much larger than UK etc. Are the incidence of EMS crashes proportional to the cities more air traffic, greater workload, building etc. Or are the same criteria relevant to the rural incidents, and that terrain situational awareness fatigue: have as much relevance to all.
to simplify. Are there faults common to rural and others common to surburbian ems crashes.
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