Have a copter, now must use it?

MMiz

MMiz

I put the M in EMTLife
Community Leader
Messages
5,615
Reaction score
490
Points
83
Around here we don't use helos. We have a couple Level 1 trauma centers 10-15 minutes away.

For those of you that use helocopters, is there any pressure to use them? I'm wondering if now that you have them in the system, is there pressure to send pts via that route to justify their purchase and make the extra $?

It may be a stupid question, but I'm just wondering.
 
two level 1 trauma centers within 10-15 mins of each other, wow!
 
We have a couple of Level 1s in Hartford. Hartford Hospital owns two helos; one is stationed on the roof of the hospital, the other in Norwich, CT. Their flight areas range from all over CT to MA, RI, VT, NH, NY, etc. They fly an average of about 1,400 pt. a year, so I'd say they're well used.

I dunno, they're a great tool, especially in rural areas when a pt. needs Level 1 care. -shrugs-
 
Its not a stupid question at all Matt. It is my belief that most hospital based systems do a sufficient amount of research to identify if the cost of a helo is justifiable. I have never seen undue pressure to utilize them. Now the private companies on the other hand are RUTHLESS in their marketing strategies and often times forget the real reason why they are in business; for the patient! You would be amazed at the tactics I have seen by companies who have no reason being in an area, trying to promise the world. The sad part is a lot of EMS agencies are dumb enough to believe them!

I work for a ground service on the north side of Houston. The two Houston trauma centers are 20 - 50 minutes away depending on the location in our district. Less than 10% of our trauma's go by air, it simply is just not needed.

1. Time - Yes the helicopter can be on the ground in 10 minutes, but then it takes them another 10 to get the patient, then followed by a 10 - 30 minute (depending on air traffic control) flight time. There is generally not a time saving benefit.

2. Medical capability - Anything that can be done in the helicopter can be done in my ambulance (except for chest tubes and not many of them are performed).

3. Patient financial aspect - Don't get me wrong, this is not towards the top of my list during an urgent or critical situation, but why charge the patient 10x's the cost when its not needed?

Just food for thought.........
 
helicopters

I work for a hospital that runs 2 helo's for the county. We actually staff a flight medic on a police based helicopter. The pilots are police officers and we respond to all police type missions and all requests for medivacs. We are the only ems agency in the area that can preform RSI, so we get called mostly for that. The nice thing for the pt is that since the heli's are from the police department and we are the only service in the county, it's free for the pt's.
 
Good question, one that is constantly brought up at meetings. My town is positioned between five level 1 truama centers, 1 20 miles West and 4 20 minutes East. West hospital has own helicopter. East (Boston) has 3 helicopters and 2 GCCT trucks. Both helo companies stay very busy covering the state and surrounding states. Personally, I never hesitate to call for a helicopter. Falls, MVAs, serious truamas basically, I try to make a decision in the first minute of assessing the patient. If they need that level of care and speed I call right away. One thing you dont want to get in the habbit of is going back and forth trying to decide. If you call for it and it was determinded that you didnt need it, oh well. If you waited to call for it then decide you need it, its too late. I have made both wrong decisions. Now I side with calling it more than not. The level of care they provide, and the speed they transport at is faster, and smoother. A helicopter will always get the patient there faster if called right away and they will also get accepted right into the level 1 truama center with whatever they need waiting for them.
 
Got choppers, don't usually see them.

A dispatcher friend says that the choppers don't get used as often as one would think except out in the boonies. Seems that our county can pull from a *bunch* of choppers, including LifeFlight, CalStar, the US Army/California Air National guard (129th Rescue Group out of Moffett Field) and the US Coast Guard.

Stanford LifeFlight - a few neat photos there.
 
well...at our County service it is a 2 hour transport to the nearest level 1 trauma center. we have 2 choppers within 10 min flight times....and 3 more within 15-17 mins. We usually have them put a bird on standby on certain things such as MVA....or motorcycle MVA. If we have cops or first responders on scene and they report patients look pretty bad then we do a Flight/Standby which has the chopper launch and head towards us and we can turn them around at anytime. We fly quite a bit out. If the weather is good enough for someone to fly and the pt needs a level 1 center they get flown. We fly'em out pretty regulary. Our preffered Air Services here are Vanderbilt Lifeflight and Erlanger Life Force....they can both have 2 patients at a time. We also have 3 other choppers close from the AirEvac Service. We keep them all pretty busy.
 
FF894 said:
The level of care they provide, and the speed they transport at is faster, and smoother. A helicopter will always get the patient there faster if called right away and they will also get accepted right into the level 1 truama center with whatever they need waiting for them.
Click to expand...

Haven't flown in an EC 135, have you????? Bumpy as hell! LOL

Sorry to disagree, but when you are 30 or less to the trauma center, you are talking a couple of minutes difference in respect to arrival. Helicopters generally are not needed for scenes in urban areas, period. The only true need, and one that I personally see can be utilized on the ground, is specialty transport teams. Trauma is not included in that definition. Load 'em and go. Helicopters, in my opinion, and of many others, should be reserved for the rural area that truly need them based on time, which by the way is the sole purpose of civilian helicopter transport. It has nothing to do with crew configuration, what they can do, or how neat their bird is. They are an ALS intercept unit with a nurse. Their sole purpose is to go fast.

As far as the notion that since they came in by helicopter, then they go straight to a bed, WRONG. I have flown in patients on more than one occasion, that has parked their rear end, backboard and all , against the trauma room wall. If a patient truly needs a room, they will get one. If not, then they wait. Mode of arrival has no bearing on it (or shouldn't at least), anyone on an ambulance should be familiar with that feeling!

@Divinewind - That is awesome that Vandy and Erlanger take good care of you. When they work together, they provide an awesome resource, especiallly Vandy's new EC-145's!! (drool, drool........) Wise choice for your first call............
 
The problem is most helo's are not were they should be .. they are in a metropolitan area, so they do not change time element.. The rural area is where they are needed the most for transport time >30 minutes.

I agree, of course with Flight LP, I too have flown in people to have them wait as well.... triage is triage, and especially if all the trauma bays are full. Transportation mode has no bearing...

Funny thins is, I believe the only people impressed with flight people are medics and other flight nurses and flight medics... LOL Most trauma ctrs., could care less, what mode I arrived in....


R/r 911
 
The Maryland State Police operates the medevac helicopters used in MD. They have eight in service at any time (they own 12, but four are reserve units), and they are stationed not at hospitals; instead, they are stationed at municipal airports. They are definitely not stationed in metropolitan areas, so I guess the MDSP Aviation Command understands what Ridryder911 was talking about.

Between the eight helicopters commands, in 2002 (the most recent year of statistics published on their website), they transported a total of about 5300 patients, ranging from 191 flown by the least-busy command to 1105 by the busiest command.

I don't believe there is any pressure to use the MDSP medevac service. The state invested a lot of money in buying 12 Eurocopter Dauphin II, and I'm sure they'd like to get their money's worth. But the MDSP does not bill for their service. The entire operating cost for the helicopters comes from an $11 "EMS" fee that's part of the vehicle registration fee in this state (the EMS fee is actually $17; the rest goes to fire/rescue and EMS agencies, and the University of MD Shock Trauma center). The salaries of the people who work on the helicopters is part of the annual budget for the state police, which comes from the usual source of taxes.

Aside from the 5300 patients transported in 2002, they flew an additional approximately 3300 missions. Some of them may have been medevac calls where they didn't end up transporting a patient for any of a variety of reasons. But keep in mind, these are state police helicopters, so you'll understand that most of these 3300 other missions were police in nature, such as tracking fleeing suspects, rescues, etc. The point is that these helicopters are going to be in service and in use anyway, so there should be no pressure to use them for medevacs, because it's not as if they won't have anything to do otherwise.
 
Around here we have MANY helicopter services.. the closest being PennStar, SkyFlightCare and University Medivac (all have a bird stationed within 5-10 minute flight time from my home.

JeffStat/Lifenet, Christiana Care/Lifenet and Maryland State Police have all been known to do scene flights in the county as well.


Some of the services are better than others... In our county, policy is, if a Field provider asks for a paticular resourse it is granted.. for example, I could specify "Pennstar" for a helicopter flight, and the county would attempt to get Pennstar first, regardless of what the established services are listed on the runcards... this isn't done often, but has been done on occasion when ship placement changes and the county hasn't caught up.

Around here, it is 45-60 minutes to a Trauma center... Several services have SOP's that say they fly EVERONE who qualifys for a trauma center.
 
Jon said:
...In our county, policy is, if a Field provider asks for a paticular resourse it is granted.. for example, I could specify "Pennstar" for a helicopter flight, and the county would attempt to get Pennstar first, regardless of what the established services are listed on the runcards...
Click to expand...
In Maryland, we're taught that if we feel we need a flyout, to make a generic request for a flyout to the medical director on call. There are two other medevac services that I know of that operate in the state are the US Park Police (they have three helicopters) and MedStar. We can ask for a specific service, like you, and we'll get what we ask for. But if we ask for MedStar, and MedStar comes and does the transport, MedStar bills the patient (or the patient's insurance) for their service...and it ain't cheap. Total cost is going to be into the five-figure range, from what I've been told. On the other hand, if we ask generically for a flyout, chances are we'll get the MD State Police, which as I described earlier, does not bill anybody. But if the MDSP is unavailable, they'll arrange for either the US Park Service or MedStar to go. I don't know what the Park Service's billing practices are, but if we call for a generic flyout, and the medical director or the state police decide to use MedStar, then the patient is not billed. I'm not sure if MedStar is paid by the state government for each instance, or if they have some kind of contract and get a flat rate, or what. But it is drilled into us to never ask for MedStar specifically, because that leads to some unhappy people getting stuck with a big bill that they wouldn't have gotten if we just asked for a flyout.
 
Up in my mom's area, we've got a bird that we've got at our disposal. In our area, it's not a bad idea to have. In my mom's town, we're more than a half hour from the nearest trauma center, and the bird can touch down a lot quicker than our ambulance people can get to the patient. -sigh-

But personally, I think it's a good tool for us to have - we can get our patients to bigger hospitals in cities like Rochester and St. Paul MN. Very handy. :)
 
c-spine said:
Up in my mom's area, we've got a bird that we've got at our disposal. In our area, it's not a bad idea to have. In my mom's town, we're more than a half hour from the nearest trauma center, and the bird can touch down a lot quicker than our ambulance people can get to the patient. -sigh-

But personally, I think it's a good tool for us to have - we can get our patients to bigger hospitals in cities like Rochester and St. Paul MN. Very handy. :)
Click to expand...

Ah, that's from the Mayo Clinic. If all goes well, my gf will get herself a job there in a few months. :D
 
Flight-LP said:
Haven't flown in an EC 135, have you????? Bumpy as hell! LOL

Sorry to disagree, but when you are 30 or less to the trauma center, you are talking a couple of minutes difference in respect to arrival. Helicopters generally are not needed for scenes in urban areas, period. The only true need, and one that I personally see can be utilized on the ground, is specialty transport teams. Trauma is not included in that definition. Load 'em and go. Helicopters, in my opinion, and of many others, should be reserved for the rural area that truly need them based on time, which by the way is the sole purpose of civilian helicopter transport. It has nothing to do with crew configuration, what they can do, or how neat their bird is. They are an ALS intercept unit with a nurse. Their sole purpose is to go fast.

As far as the notion that since they came in by helicopter, then they go straight to a bed, WRONG. I have flown in patients on more than one occasion, that has parked their rear end, backboard and all , against the trauma room wall. If a patient truly needs a room, they will get one. If not, then they wait. Mode of arrival has no bearing on it (or shouldn't at least), anyone on an ambulance should be familiar with that feeling!

@Divinewind - That is awesome that Vandy and Erlanger take good care of you. When they work together, they provide an awesome resource, especiallly Vandy's new EC-145's!! (drool, drool........) Wise choice for your first call............
Click to expand...

Well, I disagree with you on a few points. First, a helo can be bumpy at times but overall is much better than surface roads in a freightliner or international ambulance any day. As for bed acceptance, I guess its just a little different where you are. Actually you contradict yourself. You say the only reason for a helo is speed, but then they are stuck in the corner waiting?? Up here, when you fly a patient in there is a truama room, OR, Cath lab, whatever is waiting for the pt when they arrive.
 
Flight-LP said:
Haven't flown in an EC 135, have you????? Bumpy as hell! LOL

Sorry to disagree, but when you are 30 or less to the trauma center, you are talking a couple of minutes difference in respect to arrival. Helicopters generally are not needed for scenes in urban areas, period. The only true need, and one that I personally see can be utilized on the ground, is specialty transport teams. Trauma is not included in that definition. Load 'em and go. Helicopters, in my opinion, and of many others, should be reserved for the rural area that truly need them based on time, which by the way is the sole purpose of civilian helicopter transport. It has nothing to do with crew configuration, what they can do, or how neat their bird is. They are an ALS intercept unit with a nurse. Their sole purpose is to go fast.

As far as the notion that since they came in by helicopter, then they go straight to a bed, WRONG. I have flown in patients on more than one occasion, that has parked their rear end, backboard and all , against the trauma room wall. If a patient truly needs a room, they will get one. If not, then they wait. Mode of arrival has no bearing on it (or shouldn't at least), anyone on an ambulance should be familiar with that feeling!

@Divinewind - That is awesome that Vandy and Erlanger take good care of you. When they work together, they provide an awesome resource, especiallly Vandy's new EC-145's!! (drool, drool........) Wise choice for your first call............
Click to expand...


I just typed my reply and it didn't go through so heres try number 2. I disagree with you on a few points. First, a helo can be bumpy at times sure, but still better than a freightliner or international rig on surface roads any day. Next, I guess where you are its a little differant. In fact, you contradict yourself in a way. You say the only reason for a helo is speed, but then your pts just sit in the halway?? Where I am the helo gets bed acceptance immediatly to whatever they need - Trauma, OR, cath lab, whatever it is. If they are going ot be rushed there so fast only to wait whats the point?
 
Oops, okay its 530am, give me a break....
 
FF894 said:
Well, I disagree with you on a few points. First, a helo can be bumpy at times but overall is much better than surface roads in a freightliner or international ambulance any day. As for bed acceptance, I guess its just a little different where you are. Actually you contradict yourself. You say the only reason for a helo is speed, but then they are stuck in the corner waiting?? Up here, when you fly a patient in there is a truama room, OR, Cath lab, whatever is waiting for the pt when they arrive.
Click to expand...

Very true point. Some helicopters are smoother than a medium duty ambulance. But I also believe that these trucks have absolutely no business being mounted and sold as ambulances. They are too big, bulky, their center of gravity is unsafe, they are not cost effective, and they are, plain and simple, too much truck.

There is no contradiction in my post. Air medical transportation is designed for speed, plain and simple. But when your local ground EMS cannot properly utilize the resource as recent studies have shown (such as flying patients on MOI alone), then you wind up transporting stable, not medically necessary patients. Thus, we wait.........
Most air services cannot currently refuse patients once patient contact has been made. That will hopefully soon change with the continued pressure from state and federal agencies to clean up our safety record. In the mean time, we get triaged just like the next guy................
 
You must log in or register to reply here.
Back
Top