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Medical Helicopters: Worth the Cost, Risk?

john Wood johnwood237 at msn.com
Thu Apr 19 05:17:41 BST 2012


I work in a UK based HEMS unit where we offer a level of care (RSI, procedural sedation etc) in support of the established ambulance service. We view our helicopter primarily as a delivery system for the team rather than a transport medium for the patient for the reasons out lined by Ian below. The helicopter allows us to reach a greater number of patients over a greater distance and we ground assist about 66% of our patients in a land ambulance following interventions.
However the delivery system suffers from the disadvantage of not being able to fly at night or in bad weather and this is a challenge which we are working on.

John Wood
Critical Care Paramedic UK


On 19 Apr 2012, at 02:24, "Ian Seppelt" <seppelt at med.usyd.edu.au> wrote:

> As a platform, a helicopter (flying 120 - 150 km/hr) is faster than a road ambulance for more than about a 30 minute drive, when you take in to account time for startup, shut down, loading, unloading etc. For less than about a 30 min / 50km drive [depending on local geography and traffic] a road ambulance will always be quicker.
> 
> This benefit is maintained up to about a 250 km radius, when fixed wing aircraft (faster flying speed but need to take off and land from airports, with secondary road transport at each end) become overall faster.
> 
> The equation may change depending on the crew composition and casemix [taking specialist skills to the patient] but purely as a platform a helicopter is slower than a road ambulance over most urban distances.
> 
> Ian
> 
> On 19/04/12 3:14 AM, Stephen Richey wrote:
>> 1.  In certain situations yes but it generally depends on how one
>> defines "faster".
>> 2.  Prove it outside of combat zones.
>> 3.  Depends on the service.  It also begs the questions: "How often
>> are those "higher" skills actually used and to what benefit/impact on
>> survival?"
>> 4. *snort* That's a good one.
>> 
>> On Wed, Apr 18, 2012 at 1:10 PM, Caesar Ursic<cmursic at gmail.com>  wrote:
>>> What does the group think about a comment by a prominent US trauma surgeon
>>> (he was critiquing a paper on helicopter transport) that goes something
>>> like this:e
>>> "There are four myths about helicopters in trauma:
>>> 1. They are faster
>>> 2. They save more lives
>>> 3. They provide higher level of care
>>> 4. They are safe"
>>> 
>>> The paper in question is Eileen Bulger's "Impact of prehospital mode of
>>> transport after severe injury: A multicenter evaluation from the
>>> Resuscitation Outcomes Consortium" presented at the 2011 AAST meeting.
>>> 
>>> C. Ursic, MD
>>> Honolulu
>>> 
>>> 
>>> 
>>> On Wed, Apr 18, 2012 at 3:50 AM, Gross, Ronald<
>>> Ronald.Gross at baystatehealth.org>  wrote:
>>> 
>>>> I rarely disagree with Dr. Mattox, but in this case I think he has
>>>> misrepresented the ACCS COT's position on Level I vs. Level III or IV
>>>> trauma centers.  I would refer you to the current edition of the "Optimal
>>>> Resources" document, aka "the Green Book", to see how the COT
>>>> differentiates these centers , and see how the COT feels distribution of
>>>> patients should be handled.  The major issue that was not referenced in Dr.
>>>> Mattox's comment was case load/patient volume which translates into
>>>> experience, capacity and capability.  I will stop there.
>>>> 
>>>> Ronald I. Gross, MD, FACS
>>>> Associate Professor of Surgery, Tufts University School of Medicine
>>>> Chief of Trauma&  Emergency Surgery Services
>>>> Baystate Medical Center
>>>> 759 Chestnut Street
>>>> Springfield, MA  01199
>>>> 413-794-4022
>>>> ronald.gross at baystatehealth.org
>>>> ________________________________________
>>>> From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] On
>>>> Behalf Of Ian Seppelt [seppelt at med.usyd.edu.au]
>>>> Sent: Wednesday, April 18, 2012 12:47 AM
>>>> To: Trauma-List [TRAUMA.ORG]
>>>> Cc: Trauma-List [TRAUMA.ORG]
>>>> Subject: Re: Medical Helicopters: Worth the Cost, Risk?
>>>> 
>>>> Can I please clarify, if there is no medical difference between level 1
>>>> and level 3 (aside from neuro and CPB) does that mean the ambulance
>>>> services distribute the work purely on geography and not perceived 'level',
>>>> so no ambulance would drive past a level 3 to get to the level 1 20 minutes
>>>> further down the road?
>>>> 
>>>> Thanks, Ian
>>>> 
>>>> Sent from my iPad
>>>> 
>>>> On 18/04/2012, at 12:07 PM, K Mattox<kmattox at aol.com>  wrote:
>>>> 
>>>>> The greater Houston area has 5 level 1 Trauma Centers all appropriately
>>>> verified by ACS and the State of Texas.
>>>>> UTMB in Galveston
>>>>> BTGH
>>>>> Memorial Hermann Hospital
>>>>> Texas Children's Hospital
>>>>> Memorial Children's Hospital
>>>>> 
>>>>> In addition there are More Than 15 level 2 or level 3 Trauma centers
>>>>> 
>>>>> According to the ACS there is no quality difference between a Level 1
>>>> and a level 3 except for neuro trauma and cardiopulmonary bypass.
>>>>> These quality and approved trauma and acute care centers ( almost 20 in
>>>> number) cover over 500 square miles and are scattered throughout the
>>>> community.
>>>>> Real time motion data and meta analysis has demonstrated in the greater
>>>> Houston metropolitan area the time from injury and notification until time
>>>> of arrival at a trauma center is shorter in Houston than for helicopter
>>>> transport
>>>>> The only pre/ post availability study I know of is a years analysis at
>>>> UTMB (Galveston) using helicopters vs the first year after helicopter
>>>> transport was discontinued.    For same service area and severity the
>>>> mortality andorbidity was identical.    From many different methods of
>>>> analysis the various Houston metropolitan area for air ambulance can be
>>>> used to underscore an overuse and negative outcome clinical and cost data
>>>> analysis.
>>>>> k
>>>>> 
>>>>> Sent from my iPhone
>>>>> 
>>>>> On Apr 17, 2012, at 7:35 PM, Stephen Richey<stephen.richey at gmail.com>
>>>> wrote:
>>>>>> I'd like to know Dr. Mattox's thoughts on Dr. McCarthy's quote in that
>>>>>> article:  "The greater Houston area is served by just two level 1
>>>>>> trauma centers for over 5 million people," says Dr. James J. McCarthy,
>>>>>> medical director of the emergency center at Memorial Hermann Hospital
>>>>>> in Houston.
>>>>>> 
>>>>>> I hope  that was taken out of context making it sound like the urban
>>>>>> area of Houston is the ideal environment for HEMS.....
>>>>>> 
>>>>>> On Tue, Apr 17, 2012 at 8:26 PM, James Richardson<jimmnn at comcast.net>
>>>> wrote:
>>>>>>>> From ABC News:
>>>>>>> 
>>>>>>> 
>>>>>>> http://tinyurl.com/cgf54cq
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> Jim<
>>>>>>> 
>>>>>>> 
>>>>>>> 
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>>>>>> 
>>>>>> --
>>>>>> Stephen Richey
>>>>>> Founder and Chief Researcher/Designer
>>>>>> Kolibri Aviation Safety Research
>>>>>> 5174-B Winterberry Circle
>>>>>> Indianapolis, IN 46254
>>>>>> 317-985-4740
>>>>>> 
>>>>>> "I think the best thing, and the only thing in our infinite
>>>>>> inadequacy in making up for the loss of life, is to say something we
>>>>>> have been able to say in a lot of other accidents to grieving
>>>>>> families.  That is 'Those deaths will not be in vain. We will not let
>>>>>> them be in vain. Every one of those lives will be made to count in
>>>>>> terms of making sure that three, four, five or ten other people do not
>>>>>> die."- John J. Nance
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>>> 
>>> 
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>> 
> 
> -- 
> Dr Ian Seppelt FANZCA FCICM
> Senior Specialist in Intensive Care Medicine
> Nepean Hospital, Penrith NSW
> Sydney Medical School - Nepean, University of Sydney
> 
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