Washington Post does story on MedEvac crashes

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wsuffa

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Bill S.
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/20/AR2009082004500.html?hpid=topnews

Such flights are common in the highly competitive multibillion-dollar air-medical business. Although the public profile of medical helicopters has them swooping to crash scenes at the edge of highways, most flights, like Palcic's, involve shuttling patients between hospitals.

The director of the helicopter program for which Palcic flew called these lucrative patients "golden trout" and pushed pilots to reel in as many as possible. When pilots balked at flying in bad weather, he called them sissies and second-guessed them, records and interviews show.
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A little bit of sensationalism to reel in the reader....
 
I remember a news story from years ago about how dangerous the helicopter transportation could be. Some things never change. Expensive too, and on our nickel.
 
I wish they'd more clearly differentiate between factual reporting and op-ed pieces. There were certainly facts in this "story", but there was clearly an agenda too.
 
I've spent about 4 weeks at the local hospital (visiting) most of them with an unobstructed view of the helipad. Not much room for errror.
 
A little bit of sensationalism to reel in the reader....
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Actually all those comments are well backed up by facts and are not sensationalistic. It is not at all uncommon for pilots to be threatened with termination, called cowards or otherwise belittle if they choose not to take a mission, so much so that it's been repeatedly cited as a contributing factor in HEMS crashes.

You're talking about an industry that did not see last year's bloodbath as a major issue until the FAA and NTSB started sniffing around. It's a highly competitive field where it is not beneath these companies to effectively bribe EMS and fire-rescue agencies with food, clothing and other trinkets to get the first call when a possible patient comes along. The only thing sensationalistic about any of the reporting on HEMS comes from the mistaken belief that these flights save large numbers of lives annually. Helicopters do have a place in transfers between hospitals but multiple studies in the US have shown minimal to no benefit to the common practice of flying patients directly from the scene.

The article might try to downplay the number of scene responses, but they are still a significant portion of flights annually, especially in a few places where the practice of prehospital medicine has not changed much with the changing evidence (*cough* Maryland *cough, cough*) In a couple of studies, there was actually a decrease in the survival rate for patients flown from the scene to the hospital. Also, most patients that are transferred by helicopter between hospitals are not unstable and could just go by ground ambulance for far less risk and far less expense.

BTW, for the sake of disclosure, I used to be a crew member on aeromedical missions so I am not simply maligning a practice simply to hear my head rattle or because of sour grapes. I'm tired of seeing my friends and colleagues (I lost three close friends and another person I knew reasonably well last year alone) die for no particular benefit other than profits and egos.

Some further commentary (with a lot of the issues and facts discussed) on the topic:
http://strangedichotomy.blogspot.com/2009/03/response-to-post-on-rogue-medics-blog.html
http://strangedichotomy.blogspot.com/2008/11/more-bs-from-maryland-institute-of-ems.html
http://strangedichotomy.blogspot.com/2008/11/sacred-cows-reticent-physicians-and.html
http://strangedichotomy.blogspot.com/2008/10/touching-base-and-****ing-people-off-at.html
http://roguemedic.blogspot.com/2008/07/helicopter-ems-starbucks-effect.html
http://roguemedic.blogspot.com/2008/10/some-hems-crash-data-charts.html
http://roguemedic.blogspot.com/2008/10/helicopters-and-bad-science.html
http://roguemedic.blogspot.com/2009/03/msp-aviation-vs-everybody-else.html
http://roguemedic.blogspot.com/2009/03/continued-opposition-to-good-helicopter.html
http://roguemedic.blogspot.com/2009/03/helicopters-and-blogiversaries.html
http://roguemedic.blogspot.com/2009/03/welfare-queens-protest-ems.html
http://roguemedic.blogspot.com/2009/03/more-helicopter-ems-politics-and-pork.html
http://roguemedic.blogspot.com/2009/03/medevac-helicopter-improvement-act-of_03.html
http://roguemedic.blogspot.com/2009/03/medevac-helicopter-improvement-act-of.html
http://roguemedic.blogspot.com/2009/02/new-helicopter-ems-rules-proposed.html
http://roguemedic.blogspot.com/2009/02/helicopter-ems-meetings-at-ntsb.html
http://roguemedic.blogspot.com/2009/02/observations-on-ntsb-hems-hearings.html
http://roguemedic.blogspot.com/2008/11/maryland-panel-meets.html
http://roguemedic.blogspot.com/2008/11/maryland-helicopter-ems-panel-supports.html
http://roguemedic.blogspot.com/2008/10/update-on-maryland-and-unnecessary.html
http://roguemedic.blogspot.com/2008/10/response-to-dr-scaleas-letter-to-ems.html
 
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SteveinMichigan said:
Actually all those comments are well backed up by facts and are not sensationalistic. It is not at all uncommon for pilots to be threatened with termination, called cowards or otherwise belittle if they choose not to take a mission, so much so that it's been repeatedly cited as a contributing factor in HEMS crashes.

You're talking about an industry that did not see last year's bloodbath as a major issue until the FAA and NTSB started sniffing around. It's a highly competitive field where it is not beneath these companies to effectively bribe EMS and fire-rescue agencies with food, clothing and other trinkets to get the first call when a possible patient comes along. The only thing sensationalistic about any of the reporting on HEMS comes from the mistaken belief that these flights save large numbers of lives annually. Helicopters do have a place in transfers between hospitals but multiple studies in the US have shown minimal to no benefit to the common practice of flying patients directly from the scene.

The article might try to downplay the number of scene responses, but they are still a significant portion of flights annually, especially in a few places where the practice of prehospital medicine has not changed much with the changing evidence (*cough* Maryland *cough, cough*) In a couple of studies, there was actually a decrease in the survival rate for patients flown from the scene to the hospital. Also, most patients that are transferred by helicopter between hospitals are not unstable and could just go by ground ambulance for far less risk and far less expense.

BTW, for the sake of disclosure, I used to be a crew member on aeromedical missions so I am not simply maligning a practice simply to hear my head rattle or because of sour grapes. I'm tired of seeing my friends and colleagues (I lost three close friends and another person I knew reasonably well last year alone) die for no particular benefit other than profits and egos.

Some further commentary (with a lot of the issues and facts discussed) on the topic:
http://strangedichotomy.blogspot.com/2009/03/response-to-post-on-rogue-medics-blog.html
http://strangedichotomy.blogspot.com/2008/11/more-bs-from-maryland-institute-of-ems.html
http://strangedichotomy.blogspot.com/2008/11/sacred-cows-reticent-physicians-and.html
http://strangedichotomy.blogspot.com/2008/10/touching-base-and-****ing-people-off-at.html
http://roguemedic.blogspot.com/2008/07/helicopter-ems-starbucks-effect.html
http://roguemedic.blogspot.com/2008/10/some-hems-crash-data-charts.html
http://roguemedic.blogspot.com/2008/10/helicopters-and-bad-science.html
http://roguemedic.blogspot.com/2009/03/msp-aviation-vs-everybody-else.html
http://roguemedic.blogspot.com/2009/03/continued-opposition-to-good-helicopter.html
http://roguemedic.blogspot.com/2009/03/helicopters-and-blogiversaries.html
http://roguemedic.blogspot.com/2009/03/welfare-queens-protest-ems.html
http://roguemedic.blogspot.com/2009/03/more-helicopter-ems-politics-and-pork.html
http://roguemedic.blogspot.com/2009/03/medevac-helicopter-improvement-act-of_03.html
http://roguemedic.blogspot.com/2009/03/medevac-helicopter-improvement-act-of.html
http://roguemedic.blogspot.com/2009/02/new-helicopter-ems-rules-proposed.html
http://roguemedic.blogspot.com/2009/02/helicopter-ems-meetings-at-ntsb.html
http://roguemedic.blogspot.com/2009/02/observations-on-ntsb-hems-hearings.html
http://roguemedic.blogspot.com/2008/11/maryland-panel-meets.html
http://roguemedic.blogspot.com/2008/11/maryland-helicopter-ems-panel-supports.html
http://roguemedic.blogspot.com/2008/10/update-on-maryland-and-unnecessary.html
http://roguemedic.blogspot.com/2008/10/response-to-dr-scaleas-letter-to-ems.html
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You are right on in your assessment Steve. I have a lot of friends in the EMS field that will back up everything you've stated and also what was written in the article.

About 4 years ago my next door neighbor fell in her house and broke her ankle really bad. She called 911 and they dispatched a helicopter to transport her. I live out in the country but the nearest hospital is less than a 20 minute drive (probably less than 15 if in an ambulance). Her bill for the helicopter ride was $11,500.00.

A former employee of mine flies EMS up in Northern Ohio and she tells me that 90% of her flying are hospital transfers and that most of those are not critical. She also told me that when the helicopter lifts off the pad the minimal cost is $10,000.00 to start the flight.

It's all about the money.
 
SteveinMichigan said:
That's another myth about EMS: that lights and sirens decrease transport time. They don't.
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They can. It just isn't a huge difference like people tend to think. There are times when they help.
 
SteveinMichigan said:
Actually all those comments are well backed up by facts and are not sensationalistic. It is not at all uncommon for pilots to be threatened with termination, called cowards or otherwise belittle if they choose not to take a mission, so much so that it's been repeatedly cited as a contributing factor in HEMS crashes.
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The EMS industry has its problems but your statement unfairly paints all programs with the same brush. I have been involved with a program which operates both helicopters and fixed wing and they certainly didn't treat their pilots like this.
 
They can. It just isn't a huge difference like people tend to think. There are times when they help.
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Most of the studies I have seen say it is not even a statistically significant difference in most areas.

The EMS industry has its problems but your statement unfairly paints all programs with the same brush.
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There are always exceptions to what is generally held (by the NTSB, the FAA, most physicians who have research into the medical necessity of these flights, et al) as an "industry-wide problem" to quote one interview given by an NTSB spokesperson (actually if I recall correctly, it may have been the chairperson or one of the board members) during the run-up to the hearings. Hell, even the Association of Air Medical Services (the lobby for HEMS operations and about as biased of an opinion as one can get) admitted there was a problem with this when pressed about it. The truly sad thing is that the services that don't learn (for example, AirEvac Lifeteam or "ScareEvac" as they are only half-jokingly called due to their having the worst safety record in the industry) from the examples of these more professional services (Clarian Lifeline and one service in Maine (the name eludes me at the moment, but then again having a few beers at a reunion has that effect on one's memory) for example) are doing so simply out of greed and hubris. The fact that they have damn fine services who are willing to work with them to improve their safety and keep the NTSB/FAA at bay and allow crews to return home to their loved ones at the end of a shift in something other than in a body bag is among the most despicable practices in aviation.
 
Here are the two I found in really brief search.

Source: Ho J, Lindquist M: Time saved with the use of emergency warning lights and siren while responding to requests for emergency medical aid in a rural environment. Prehosp Emerg Care. 2001 Apr-Jun;5(2):159-62.
ESULTS: The 32 responses with L&S averaged 105.8 seconds (1 minute, 46 seconds) faster than those without (95% confidence interval: 60.2 to 151.5 seconds, p = 0.0001). The time difference ranged from 425 seconds (7 minutes, 5 seconds) faster with L&S to 210 seconds (3 minutes, 30 seconds) slower with L&S. CONCLUSION: In this urban EMS system, L&S reduce ambulance response times by an average of 1 minute, 46 seconds. Although statistically significant, this time saving is likely to be clinically relevant in only a very few cases. A large-scale multicenter L&S trial may help address this issue on a national level.
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To be fair, I also found this article that I am not sure of the validity of since it had such an awfully small sample size to make such a broad statement and also I also question the standard they are using for "rural" among other things (average posted speed limits on the roads, the terrain and road contour, etc) that are not addressed in the abstract that could cause a significant difference in response times where you are driving strictly adherent to the traffic laws and then when you are violating them when running lights and sirens. Also the fact that they spread 67 studied calls over almost two years seems kind of odd....not sure why they would do that. I'm still a little too tipsy to pull it and look at it in depth, but here you go.....:

Brown LH, Whitney CL, Hunt RC, Addario M, Hogue T: Do warning lights and sirens reduce ambulance response times? Prehosp Emerg Care. 2000 Jan-Mar;4(1):70-4.
RESULTS: Sixty-seven runs were timed during a 21-month period. The average code 3 response interval was 8.51 minutes. The average code 2 response interval was 12.14 minutes. The 3.63 minutes saved on average represents significant time savings of 30.9% (p < 0.01). Shorter runs had higher time savings per mile than the longer runs. Run distance was the only variable that was statistically significant in affecting time saved during a code 3 response. CONCLUSION: Code 3 operation by EMS personnel in a rural EMS setting saved significant time over code 2 operation when traveling to a call.
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The main thing that is lacking here is evidence that the response time is going to be clinically relevant, as the first abstract mentioned. Also, since we're discussing the benefits of transport to trauma centers, etc by helicopter versus ground, I am going to try to find an article I read several years back that looked at transport time (as opposed to response time) for ground ambulances with and without lights and sirens since that is what is most pertinent here and not looking at a separate situation and trying to extrapolate to another. Sorry if this is a little disjointed....
 
In the "old" days where all you got in the field was BLS, the mantra was to get to ALS facilities quickly. I can believe (though I have no statistics) that lights and siren made a difference in those cases.

Nowadays where the standard of care in the field is much higher, I think transport time matters less, except maybe in cases where rapid surgical intervention is required.
 
SteveinMichigan said:
Actually all those comments are well backed up by facts and are not sensationalistic. It is not at all uncommon for pilots to be threatened with termination, called cowards or otherwise belittle if they choose not to take a mission, so much so that it's been repeatedly cited as a contributing factor in HEMS crashes.

You're talking about an industry that did not see last year's bloodbath as a major issue until the FAA and NTSB started sniffing around. It's a highly competitive field where it is not beneath these companies to effectively bribe EMS and fire-rescue agencies with food, clothing and other trinkets to get the first call when a possible patient comes along. The only thing sensationalistic about any of the reporting on HEMS comes from the mistaken belief that these flights save large numbers of lives annually. Helicopters do have a place in transfers between hospitals but multiple studies in the US have shown minimal to no benefit to the common practice of flying patients directly from the scene. ...
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Agreed. 100%.

I consider myself fortunate that the area I live in is served primarily by an organization that does not meet that description. Hermann Hospital's Life Flight has existed since the 70's, is operated by a not for profit hospital chain, and has always empowered its pilots with go/no go authority over weather, and in over 20 years of being in healthcare that reputation stands up. Its reflected in their accident rate, which they are way below average, and has never been because of weather. I seem to recall a rotor strike in the mid 80's while departing a parking lot while the hospital pad was being rebuilt, an engine fire in the early 90's.. and an unforseen rotor assembly failure in the late 90's that had never happened before, and resulted in new inspection and life limits on the BK 117 TT straps. I do remember more than one occasion of picking up the crew (and patient at times) when they landed out, due to deteriorating weather, and finishing the trip by ground.

In the past 5-6 years a for profit competitor has emerged, and they've been in the news more than once. A flight into bad weather that Hermann had already aborted, crew with patient killed. Allegations of kickbacks - a fire chief I've known over twenty years was interviewed on camera about them and reports that his department was offered money for every flight they called them out for (they didn't take the offer)... A local EMS territory going from 8 flights a year to over 100 a year with a helicopter staged in territory/dedicated for their use... when most times a ground crew can get to the hospital just as fast by ground. I place the blame for this on the corporate button pushers, not the working stiffs in the flight suits on the scenes..

The for-profit providers have a different goal and a different approach, and it shows when the facts come to light.
 
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Nowadays where the standard of care in the field is much higher, I think transport time matters less, except maybe in cases where rapid surgical intervention is required.
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Actually still the best course of action is to treat en route. Most advanced life support (ALS) interventions have minimal effect on patient outcomes.

I place the blame for this on the corporate button pushers, not the working stiffs in the flight suits on the scenes..
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Agreed, at least to a limited point. Although I've run into some folks from AirEvac Lifeteam on scenes where they are hell bent on transporting anyone they can get their hands on. One incident I pointedly remember was where they landed on scene without being formally called for. The investigation by the county revealed that the "dispatch call" came from a volunteer firefighter from a neighboring jurisdiction who had happened upon the accident and called it into 911, hung up and call AirEvac Lifeteam to request the helicopter. He "happened" to work for them as a flight paramedic (he doesn't any more since our medical director had his certification revoked for unprofessional conduct).

In this particular case, all of the viable patients from the scene were already be transferred to hospitals by ground and I wound up in a very heated argument with the AEL flight nurse about whether the deceased victim who had been thrown from one of the cars should be flown to the closest trauma center. She seemed to think that it was a good idea- despite the fact that the survival rate from cardiac arrest following blunt trauma is something on the order of <0.5% and this particular patient had been declared dead 20+ minutes before. The fact that a large portion of his brain was no longer in his skull also did not seem to affect her assessment of the situation either.

The corporate types may be to blame for enforcing such attitudes as "every flight must result in a transport" but they tend to select employees who are willing to espouse the same attitude. The crews bear some responsibility by taking part in unethical treatment and transport practices. Just because you can wrap yourself in the warm and cuddly blanket of alleged humanitarianism, does not absolve a bright and competent medical professional from his or her duty to put the patient before the profit margin of his or her employer when failing to do so puts the patient and everyone else involved at grave risk.
 
The Post story was first in a series. They've run front-page stories all week, culminating with a 2-full-pages story in today's (Sunday) paper. The subject of today's story was the crash of the Maryland helicopter on approach into Andrews last year.

Worth a read.
 
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