A Case for Air Rescue

Having read last weekend's informative series on the air medical business by The Washington Post, I was reminded of the OH&S cover story of June 2007 that combed some of the same ground. In particular, I recalled Joni Sidler, one of my sources for that story. An EMT instructor at a junior college, paramedic with a fire department 12 miles south of Dallas, and mother of a 19-year-old son who sustained multiple skull and facial fractures in a traffic accident that left him in a coma for 17 days, she was a uniquely qualified source for the piece and a compelling person to interview.

The Post's editorial team took live questions Monday from readers, telling one they expect FAA will propose new regulations on the air medical industry -- but not until 2011. One question from a Baltimore reader brought Sidler and her story strongly back to mind -- so much so that I could hear her voice again as though it were yesterday instead of the more than two years it's been since I interviewed her. The reader asked, "Is any of this helicopter transport really needed? Is there any data to show improved outcomes of the patients?"

Sidler's answer to the first part of the question was an unequivocal yes. She credited the medical helicopter transport her son John received the day of his accident -- along with the family that dialed 911 and some fast-acting paramedics -- for helping to save his life. For while her son's accident in Dallas took place not far from a hospita, close enough that a ground ambulance might have been used, traffic was badly congested on that rainy Saturday, and his head injuries were traumatic. According to Sidler, time was of the essence, and every second counted.

"In EMS, what we teach is 'the Golden Hour,' and that's the time from when the accident happens -- not from when 911 is called, but from when the accident happens -- until that patient can get into the OR," Sidler said. "Because of the extent of his injuries, John didn't have even that long. Fortunately, they were able to get him there as quickly as they did." At the time I was talking to his mother, John was 21 and fully recovered, working his way through college.

The ability of the medical helicopter to "jump" traffic and get Sidler's son to the helipad atop the nearby hospital in minutes that day was crucial. But as both the OH&S article and The Post series point out, medical helicopters are often at least equally useful in sparsely populated rural areas, where many of their bases are, in fact, strategically located. It is in rural areas where, according to the National Highway Traffic Safety Administration, most serious car crashes and 60 percent of auto fatalities in the United States occur, at a rate nearly double that of urban and suburban areas. According to the Center for Excellence in Rural Safety, which Congress created in July 2005, crash victims are five to seven times more likely to die if arrival time to a hospital exceeds 30 minutes.

The average time between a crash and arrival at a hospital is 52 minutes in rural areas, the center says. Helicopter operations in rural outposts are seen as helping to close the time and space gaps between these remote vicinities and the tertiary care hospitals situated in metropolitan areas.

In answer to the second part of the Baltimore reader's question, regarding the availability of data to show improved outcomes of helicopter-lifted patients, the Post reporters noted those data are not readily available. "There have been several studies published over time, but they have been relatively limited in scope," responded Post writer Gilbert M. Gaul. "As best as we can tell, the government doesn't collect data and most of the large operators don't publish their outcomes data. We asked several for data on things like 24 hr discharges and ISS scores for transported patients but were told the data were proprietary."

Gaul added, "The data gap begs questions about appropriate vs. inappropriate use and the value various payers are getting for the transports. Without questions, medical helicopters can play a vital role in the system. We aren't questioning that. The question is what is the appropriate role?"

Posted by Ronnie Rittenberry on Aug 26, 2009