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Fri Jan 14 05:16:21 GMT 2005

Ken

>From an international perspective, I have to agree with you, particularly for Trauma, although I think the only place for urban air ambulances MAY be where it is the ONLY source of ALS personnel available for a large area, if all road ALS personnel are unavailable. This often happens in the province where I work! (We have ONE EMS heli for a population of 4,5 million people, 05h00 till 09h00 daily). There is at any time usually only 16 ALS units for the same size population at any one time on a GOOD day.

Tim
Dr TC Hardcastle
M.B.Ch.B(Stell); ATLS(I), DSTC(I); M.Med(Surg)(Stell); FCS(SA)
General Surgeon (Sections Trauma / ICU)
Dept. General Surgery
University of Stellenbosch / Tygerberg Hospital
PO Box 19063, 7505
Operational Head: Diana, Princess of Wales Trauma Centre
Program Coordinator: Emergency Medicine
Intern Rotation Coordinator: Surgery

tch at sun.ac.za <mailto:tch at sun.ac.za> 
2 Lorient Close
Vredekloof
Brackenfell
7560, W. Cape
South Africa
Cell: +27824681615
Home: +27219813098
Work: +27219384911 pager 0302

-----Original Message-----
From: KMATTOX at aol.com [mailto:KMATTOX at aol.com]
Sent: Thursday, January 13, 2005 5:30 AM
To: trauma-l at lists.aast.org; trauma-list at trauma.org
Cc: ccm-l at ccm-l.org
Subject: Re: Va heli crash

Condolences to the families of those who died in this air ambulance  
helicopter crash.   May the nurse survivor have a rapid  recovery.   

Although this is never a good time to talk about the efficacy and safety of  
helicopter operations as air ambulances, if we keep talking around the issue,  
there will NEVER be a good time.    If there is class 1 efficacy  data 
demonstrating a survival advantage and documenting a need for air ambulance  
helicopters for anything other than wilderness, high rise and off shore rescue,  then 
now is the time for that data to be shared by all of us.   We  have ignored 
the many "out of control" issues regarding helicopter air  ambulances far too 
long.   To have lost 34 people in helicopter air  ambulance crashes this past 
year is far too many, especially if this expensive  ambulance platform (10 X) 
does not have a survival advantage.   Some  of the Class I data does show a 
survival disadvantage and an increase in time  for air ambulance vs ground 
ambulance transport for most urban and suburban  missions.   Overflights over 
qualified hospitals for obstetrical,  trauma, and medical conditions to take the 
patient to the hospital that  advertises its name on the side decrees the logic 
for air ambulance to speed  care.    

Many of the air ambulances are OUTSIDE regional trauma  systems.    
Interventions performed by air ambulance crews are  often OUTSIDE the trauma QA review. 
 Our responsible professional  minds mandate that we take a hard look at this 
issue, and the safety of this  marketing platform.    Even the data on 
patients with head  injury who become organ donors demonstrates that the recovery 
rate  for donors is greater when taken by ground ambulance.   The  incredibly 
short distances of many of the flights screams for an  explanation.   The 
duplicative and excessively expensive  helicopter air ambulance services in 
communities that do not have  epidemiological justification for even ONE helicopter 
raises questions of scarce  health care dollar utilization.    

Finally, the extremely provocative report in J. Trauma by Dr. Bill Miliski  
of Galveston comparing a period of time during and after availability of  
helicopter air ambulance, demonstrates no change in outcome after the helicopter  
service was terminated raises HUGE questions of helicopter benefit to all  
thinking people.     

I recognize that the economic marketplace for this business is very  
powerful.   There have even been threats of physical injury  retaliation suggested to 
those who would challenge this helicopter  industry.    However, should the 
data which we all now have,  including our government, be analyzed for drugs or 
devices such as Vioxx,  carotid stents, coronary stents, heart valves, and 
many other examples from the  past 10 years, there would be federalized and 
regulatory drug and device  recalls.     

It is time to scientifically justify the helicopter air  ambulance.    Since 
the mid 1960s, I have been following the  literature on these flying platforms 
and the ground ambulances and the entire  EMS and trauma systems.    I find 
lots of "me too" articles, but  efficacy justification over and above ground 
ambulance EMS organized trauma  systems, I simply cannot find, as we apply far 
more than 90% of the  flights.     

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Va heli crash