Medevac flights may get new rules

Make everyone flying in one of those deathmoths use car seats. Problem solved.:wink2:
 
Or tell the NTSB, "Fine, we won't fly at all, and you can take the blame for the extra lives we didn't save."
 
No matter. After medicare chops reimbursement to the operators in 2012, air evac won't be something we'll see much of anymore.....

More requirements, more liability and less $$s is our federal government at work.
 
If they stop making headlines with their crashes, the NTSB will leave them alone. Now, how are they going to do that?
 
Ron Levy said:
If they stop making headlines with their crashes, the NTSB will leave them alone. Now, how are they going to do that?
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So, is the problem the crash, or the resulting headlines?

It would be interesting to see how many fatal ground ambulance accidents there are a year compared to airborne accidents, and how many patients die that way.

It's all about whether the patient has a better chance of survival taking the airborne route. It shouldn't be about how good those chances are - they may both be "bad".
 
TMetzinger said:
So, is the problem the crash, or the resulting headlines?
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If there's no crash, there's no headline. Prevent the crash, you prevent the headline. But as long as there are news media, medevac helo crashes will make headlines. Do the math.
 
Ron Levy said:
If they stop making headlines with their crashes, the NTSB will leave them alone. Now, how are they going to do that?
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It's simply not possible to have a zero accident rate.
 
Bob Noel said:
It's simply not possible to have a zero accident rate.
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I agree. But the vast majority of the accidents that are making the headlines would be, as the NTSB notes, preventable with the improvements they recommended (autopilots for single-pilot operations, terrain awareness systems, and night-vision systems). The fact that a zero accident rate isn't a realistic goal doesn't mean we can't attack the parts of the problem we can fix mechanically with available technology.
 
TMetzinger said:
It would be interesting to see how many fatal ground ambulance accidents there are a year compared to airborne accidents, and how many patients die that way.
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I couldn't find a statistical comparison between HEMS and ground ambulance accidents but I did find this.

http://www.ntsb.gov/speeches/sumwalt/acep-10052009.pdf

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I don't see ground ambulance drivers anywhere on that graphic.

TMetzinger said:
It's all about whether the patient has a better chance of survival taking the airborne route. It shouldn't be about how good those chances are - they may both be "bad".
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It's really not just about the patient. As the pilot you need to remember there are at least one and usually two other crewmembers to think about. I have a background in fixed wing air ambulance and I clearly remember being warned about this.
 

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Coincidentally, the Bureau of Labor Statistics just put out the statistics for last year (without separating out air ambulance workers), and pilot remains the third most dangerous job in the US: nytimes article
 
EdFred said:
Or tell the NTSB, "Fine, we won't fly at all, and you can take the blame for the extra lives we didn't save."
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Thing is... they really really dont save that many lives. A review of the studies reflects that.

Many of the vendors are for profit operators selling subscriptions in addition to being available for general public 911 or private transfer.

They (as an industry) dispatch into sometimes marginal weather, to remote, impromtu LZ's that do not have any semblence of an instrument approach, in a single pilot VFR craft. Yes.. some have NVG's.. yes.. some have IFR capability and Special or Standard instrument approaches to helipads, predesignated LZ's and airports, and the like.

When helicopter EMS started, there were very few operators. Those that existed were either government operated or non-profit operated. There were very few trauma centers and very few trauma trained providers. Emergency room doctors were GP's and internists and general surgeons who moonlighted in the ER, and there was no specialized training for the docs and nurses.

Paramedics were relatively rare, ESPECIALLY in the suburbs and rural areas. So.. back in the day... if you lived way out in the boonies, and you had someone severely injured who managed to survive the initial accident, your local EMT;s (not nearly as capable as paramedics) would call in the bird, and you would get a trauma resident physician and or a flight nurse(s) and or a flight paramedic(s) (pick 2 to 3 of the three). The few providers and few aircraft brought skills to the scene that were scarce, and made a difference in stabilization and then rapid transport.

Fast forward. In the 20 years since I've become a paramedic (and nurse) I've seen the number of helicopters and providers explode. These services market themselves as a "convenience" and you can get your patient to the trauma center faster, smoother and get your truck back in service sooner. Thats about all they have to offer now, because even your non-trauma centers are staffed with Emergency Medicine trained docs, many times your outlying ER's are staffed with nurses who cut their teeth in the increasing numbers of major trauma centers, and just about everywhere has paramedics or at least EMT Intermediates (which for trauma are usually skilled enough to do what is needed)

I lived and worked 20 miles from a trauma center when i was in EMS. Unless it was rush hour, I proved time and time again that I could get a critically injured patient into the trauma bay before the helicopter could be alerted, spool up, fly out, get the patient fly back and unload. And my out of service times were rarely much worse than the medics who were addicted to flying patients out. I only flew when it made sense - patient entrapment - the helicopter would be there before we could cut someone out of a mangled car... the remote far ends of our territory.. stuff like that.

Its no surprise that medicare is cutting the cord to this industry. Theres about to be some right-sizing.
 
Doggtyred said:
Thing is... they really really dont save that many lives. A review of the studies reflects that.... <snip>
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What Dave said.
In my 20+ years in this realm, including time at Tampa General Aeromed and Childrens' Hospital Flights, I have seen exactly what he said.

Outside rural areas, or places like Colorado where you have communities with extremely long ground transport times (or in winter where the skies are clear but the roads are still closed from the snowstorm yesterday, or the pass is closed and the long way adds two hours transport time), medevacs are grossly overused.

That said, there is a place for medevacs.
 
Everskyward said:
I couldn't find a statistical comparison between HEMS and ground ambulance accidents but I did find this.

http://www.ntsb.gov/speeches/sumwalt/acep-10052009.pdf

attachment.php


I don't see ground ambulance drivers anywhere on that graphic.

It's really not just about the patient. As the pilot you need to remember there are at least one and usually two other crewmembers to think about. I have a background in fixed wing air ambulance and I clearly remember being warned about this.
Click to expand...


I think when I was doing helo medevac work (in the USCG <insert semperparatus.mp3>) we did a good job - our criteria for rescue launches were pretty strict and reflected the fact that there was a very limited set of circumstances where we'd result in a better outcome than launching a boat.

I also agree that in most locations medevacs are overused, and that there are some places where they can make a big difference.
 
I believe it was around 1989 in my then home of Lubbock Texas. At the time I was a Med Tech at Methodist Hospital there. There were three major hospital/trauma centers in the city of probably 350,000. Methodist has just completed a study that concluded (rightly so) that helicopter medevacs from the surrounding communities (there are many) would not decrease the time from trauma to trauma center. The decision was made not to get the copter. Three months later, the Health Science Center (the med school hospital) purchased a helicopter. No more than three additional months Methodist had its copter. Kinda' illustrates one major reason the health care industry is in the shape it is in today, huh... I am now in SE Texas 20 miles from the nearest trauma center (~25 minutes by ambulance thru a small community between us and Beamont). We have air ambulance service, and as a volunteer firefighter, we set up LZ's. I have never been to one of these scenes where it looked to me like any time was saved (indeed the time was longer in many instances). The only times they have been valuable is in the case of severe burns or other critical movements to longer distance facilities like Galveston burn center -- and in some cases there is a smoother transfer. Silsbee had a brand new state of the art emergency room in our little hospital when it was closed ~10 years ago. I am sure the good Doctors on this board will concur that emergency trauma centers lose money, and this is precisely what the rural areas need. Hence, helicopters, tho not really effective, seem to give the appearance of some sort of solution to this problem. The golden hour is just about shot in this neck of the woods...end of rant. On a positive note, the teams on these medivacs are second to none -- most accidents I heard of they were pushing the envelope trying to get a patient inside that golden hour.
 
May not add much to the discussion but 3 more dead (entire crew) here in Arkansas early this morning(4AM). Medivac helicopter down on the way to pick up a heart attack patient in a rural area. Went down some distance from the objective so probably a mechanical problem enroute. Were equipped with NVG.
 
Merf said:
I am sure the good Doctors on this board will concur that emergency trauma centers lose money......... The golden hour is just about shot in this neck of the woods...end of rant.

On a positive note, the teams on these medivacs are second to none -- most accidents I heard of they were pushing the envelope trying to get a patient inside that golden hour.
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I'm not a doc, but I can easily concur that Trauma Centers are a money loser. That is why Texas dept of health gives "dispro money" (disproportionate share funding) for Level 1 and 2 Trauma Centers in the state: they share a heavier burden of expensive, uninsured care by a result of being a trauma receiving center. Hell, they even lose a bit of money being a level 3, which is what your average suburban non-teaching hospital is equivalent (whether they seek accreditation or not) because the record keeping and data reporting requirements cost 1-2 FTE's to accomplish.

As for the golden hour, while its not been "debunked" the 1 hour time frame has been de-emphasized to be more along the lines of rapid transport to stabilizing care. A stab wound to the chest who arrests in front of a crew has about 10-15 minutes of salvageability as opposed to a blunt trauma (MVA rollover with internal bleeding) possibly being salvageable longer than that. Its injury dependent, and relies on the depth of the shock state caused by trauma.

The helicopter can help in the second case.. its a waste of time and money in the first.

And it may be hype or bs, but I've noticed a difference in the quality of aeromedical crews operated by non-profit or governmental outfits and those in the for-profit community. Both are sharp... and both claim to take the best of the best, but I still claim the difference exists.
 
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