Tuesday, November 16, 2010

Helicopter Ambulances - The better-safe-than-sorry scare tactic

The grounding of Airbus A380 airplanes sporting Rolls Royce Trent 900 engines was certainly warranted following the in-flight disintegration of an engine on a Qantas flight from Singapore. But what has made global news for more than a week now, also demonstrates a dramatic disparity in aviation safety. The Airbus near-disaster is being treated with tremendous respect. 
Yet, across the United States, another sector of the aviation industry is crashing aircraft at a rate equal to an airline disaster every day and unbelievably, this carnage is accepted as the cost of doing business.
I'm talking about business of medical transport and the price paid by patients who are moved by air.

Last week, Nanci Wilson of KXAN in Austin, Texas reported on the case of Oscar Vaz. His 12-year old daughter bumped her head at summer camp in June. Now that's not news; everyone knows that bumps, bruises and bug bites are part of the camp experience like campfires and ghost stories. Only in this case the camp called for an ambulance, and it wasn't the four-wheeled variety that showed up it was a helicopter. After a brief visit to the hospital, the girl was released back to camp with a clean bill of health and not long after that, Oscar Vaz received a bill for $16,000.

What the better-safe-than-sorry philosophy costs
Oscar is one smart daddy and he started to wonder just what motivated such a drastic response to a simple bump on the noggin. What factors led to the decision to bundle the child into a helicopter and on to Dell Children's Medical Center? 
Critical attention from a doctor couldn't have been the issue since the helicopter flew right past two hospitals located closer to the camp. And there was no stated need for some highly sophisticated medical technology only available at the medical center in Austin. Oscar was mystified.
"If it is important enough to call an air ambulance, then why not go to the hospital that's 30 minutes away?" he asked me rhetorically when he called this summer. 
I didn't know Oscar then. He came across some of the many articles I've written on this subject when he started researching air ambulances. He got in touch because he was trying to understand the money machine that is today's for-profit air ambulance business. 
But Oscar didn't need much from me. He was already asking the right questions. When the bill arrived, Oscar asked why the 9-11 dispatchers called - then cancelled - Starflight, the Travis County public service helicopter, a taxpayer-supported service which would have cost considerably less, and instead dispatched the for-profit air ambulance Air Evac? If speed was the issue, why did it take the 90 minutes to get the child to the Austin hospital which is only a 50 minute drive from the camp?
Surely, Oscar thought, there must be some standard operating procedure used for determining when an air ambulance is needed and when it is not especially considering that medical helicopters are themselves, not particularly safe
What Oscar didn't know - and if you ask me, it's a good thing for his peace of mind that he did not - is that the period of time in which his daughter was flown; the hours between 10 pm and 6 am or what's called "backside of the clock" are the most dangerous hours to fly by helicopter medivac. Nearly half of all the EMS helicopter crashes take place during this time and they are almost four times more likely to result in fatalities than helicopter accidents occurring during the day. So Oscar and his daughter had two things to be thankful for; No medical problems and no unhappy landing.
But there is that whopping bill from Air Evac. And I think that Oscar, and others who have been transported by air unnecessarily feel companies like Air Evac are playing them for fools. 
Their complaints, however, always get reduced to the argument that they are better-safe-than-sorry, that air transport is worth the cost because, after all, a life is on the line. This is the bread and butter scare tactic used by the helicopter ambulance industry and you don't have to go farther than the comment section on this blog to read the endless varieties on that theme.
But one thing aviation does well is the cost benefit analysis and this better-safe-than-sorry argument doesn’t hold up to that scrutiny. So before Americans go any farther embracing the booming business of air ambulances, its critically important to analyze how the industry got cross-wise with safety and study the programs that seem to be doing things right.
And with that I’ll leave you with the promise that these are the subjects I discussed recently with Dr. John Morris Jr., director of Vanderbilt's Lifeflight program, which will be featured in an upcoming post.



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