Future of air ambulances?

[rocks25]

Howdy - Just wondering what the aviation world thinks about the future of air transport for medical reasons - I was talking with a Paramedic friend of mine and he seems to believe that for all but the absolute worst disasters, the medical care they are able to provide on the ground and at the site has improved and he sees less need for aircraft to support medical transfers in the future - because patients will be stabilized and treated more on site than they have in the past.

I'm not sure I agree with him, but I'm pretty far removed from the day to day of that world, although I certainly have an interest in aviation and i'm as fascinated as emergency medical care - what do you guys think?


http://www.cbc.ca/news/canada/british-c ... -1.3737987

[SuperchargedRS]

Howdy - Just wondering what the aviation world thinks about the future of air transport for medical reasons - I was talking with a Paramedic friend of mine and he seems to believe that for all but the absolute worst disasters, the medical care they are able to provide on the ground and at the site has improved and he sees less need for aircraft to support medical transfers in the future - because patients will be stabilized and treated more on site than they have in the past.

I'm not sure I agree with him, but I'm pretty far removed from the day to day of that world, although I certainly have an interest in aviation and i'm as fascinated as emergency medical care - what do you guys think?


http://www.cbc.ca/news/canada/british-c ... -1.3737987

Ask your friend about how time lapsed and your myocardial work, or a stroke, time is brain/heart and that stuff doesn't grow back.

Secondly, most air medical transports have medical crew who are FAR superior to ground crews.

Plus for many flights it's much smoother.


Multi system trauma, 5hr bus ride on crap roads to the definitive level of care, or 45 min in the aircraft.


Especially in wide open places like much of Canada, Alaska, etc, air EMS ain't going anywhere.


Has your friend worked as a flight medic?



*I should add I'm a medevac pilot.

[Rowdy]

Just as a heads up, the fixed wing air ambulance operations don't move patients unless they are stable. Generally a clinic or health center or small hospital will have stabilized the patient well prior to their trip on the airplane.

As superchargedRS already mentioned, the air transport crews are trained to a considerably higher standard and are usually far more experienced.

On the fixed wing side, nine times out of ten it is to bring patients from a community that does not have the specialized care they require. Unless we can afford to park a doctor and equipment for every specialty in every community, the current system will remain the most effective. The rotary side is for those immediate and life threatening incidents that are incredibly time sensitive.

There are also a lot of repatriation flights paid for by the insurance companies, as well as critical organ transfers.

Your friend seems removed from the system in such a capacity that he is unaware of the purposes for it. With many friends and colleagues involved on both the ground and air side of the EMS and health systems and having been involved myself, It would be safe to say that their have not been any advancements in initial care from paramedics that will negate the use of the air services.

[SuperchargedRS]

Just as a heads up, the fixed wing air ambulance operations don't move patients unless they are stable. Generally a clinic or health center or small hospital will have stabilized the patient well prior to their trip on the airplane. ....

Not true, at least for us.

On the fixed wing side, nine times out of ten it is to bring patients from a community that does not have the specialized care they require. Unless we can afford to park a doctor and equipment for every specialty in every community, the current system will remain the most effective. The rotary side is for those immediate and life threatening incidents that are incredibly time sensitive.

....

Our program is the same as a rotor wing, we move major trauma, major medical, very critical pt.s, etc For the fixed wing, we have airports at the right locations that, even though we have ground legs, our 240+kts vs a rotors 120kts make our times comparable for our short hops to our nearby level 1 trauma/MI/stroke/etc center. We also have the ability to fly IFR in known ice, this is a silver bullet in the winter time, and our boots have saved a good number of lives.

Many times our med crews will offer a same level, or actually a higher level of care compared to the small local ERs, when it comes to a MI, stroke, lots of traumas, there isn't much the small ERs can do that we can't.

[FighterPilot]

Job Security. This is why I love my job as a MEDEVAC pilot. Air Ambulance is going to be around for a loooonnnng time in Canada.

[co-joe]

A large number of the trips are stable patient transfers. Lots of them walk on. Only the big cities have MRI, CT, and specialists to do procedures like angio's, and whatever else. They go by air because it's cheaper, safer, the level of available service is higher, and its faster. This won't change.

[Bede]

Here's a better questions: is air ambulance financial justified?

To start with, governments and organizations quantify the cost of a life. This is why some drugs are not available in some provinces, dangerous curves in the road aren't rerouted, etc. I know the Ontario Ministry of transportation costs out a life at about $600k for road work. (A friend of mine was the guy responsible for doing these analysis).

Now try to determine the cost of an air ambulance service per life saved. Many Ill patients could go on the next scheduled flight and survive. Then there's the critically ill ones. Subtract off the ones who would survive if intervention was delayed and the ones who will not survive hospital discharge. That's the number of lives saved. My guess is that the actual lives saved are considerably less than commonly assumed. Then divide the immense cost of air ambulance services by lives saved.

Just a point of academic discussion.

You can make the same argument with land ambulances vs. taxis.

[SuperchargedRS]

Here's a better questions: is air ambulance financial justified?

To start with, governments and organizations quantify the cost of a life. This is why some drugs are not available in some provinces, dangerous curves in the road aren't rerouted, etc. I know the Ontario Ministry of transportation costs out a life at about $600k for road work. (A friend of mine was the guy responsible for doing these analysis).

Now try to determine the cost of an air ambulance service per life saved. Many Ill patients could go on the next scheduled flight and survive. Then there's the critically ill ones. Subtract off the ones who would survive if intervention was delayed and the ones who will not survive hospital discharge. That's the number of lives saved. My guess is that the actual lives saved are considerably less than commonly assumed. Then divide the immense cost of air ambulance services by lives saved.

Just a point of academic discussion.

You can make the same argument with land ambulances vs. taxis.

IMO those are not air ambulance, just a charter with a sick person.

I have never had a pt board my fixed wing who could walk on, maybe 15-20% of our pt.s could be even somewhat considered stable.

Think we have different definitions of a air ambulance/medevac.

[ant_321]

Here's a better questions: is air ambulance financial justified?

To start with, governments and organizations quantify the cost of a life. This is why some drugs are not available in some provinces, dangerous curves in the road aren't rerouted, etc. I know the Ontario Ministry of transportation costs out a life at about $600k for road work. (A friend of mine was the guy responsible for doing these analysis).

Now try to determine the cost of an air ambulance service per life saved. Many Ill patients could go on the next scheduled flight and survive. Then there's the critically ill ones. Subtract off the ones who would survive if intervention was delayed and the ones who will not survive hospital discharge. That's the number of lives saved. My guess is that the actual lives saved are considerably less than commonly assumed. Then divide the immense cost of air ambulance services by lives saved.

Just a point of academic discussion.

You can make the same argument with land ambulances vs. taxis.

IMO those are not air ambulance, just a charter with a sick person.

I have never had a pt board my fixed wing who could walk on, maybe 15-20% of our pt.s could be even somewhat considered stable.

Think we have different definitions of a air ambulance/medevac.

Depends on the province I believe. I have friends who fly medevac in a place where the patient is never sent until they are 100% stable. One has been doing it for many years and has never had a patient die on board and only saw blood a couple times. And they are the only show in the province. Another friend working in another province has had quite a different experience in the short period of time he has been doing it.

[co-joe]

Here's a better questions: is air ambulance financial justified?

To start with, governments and organizations quantify the cost of a life. This is why some drugs are not available in some provinces, dangerous curves in the road aren't rerouted, etc. I know the Ontario Ministry of transportation costs out a life at about $600k for road work. (A friend of mine was the guy responsible for doing these analysis).

Now try to determine the cost of an air ambulance service per life saved. Many Ill patients could go on the next scheduled flight and survive. Then there's the critically ill ones. Subtract off the ones who would survive if intervention was delayed and the ones who will not survive hospital discharge. That's the number of lives saved. My guess is that the actual lives saved are considerably less than commonly assumed. Then divide the immense cost of air ambulance services by lives saved. The math works and fixed wing aeromedical saves time and money. Not every time, but over the long term it is less expensive.



Just a point of academic discussion.

You can make the same argument with land ambulances vs. taxis.

IMO those are not air ambulance, just a charter with a sick person.

I have never had a pt board my fixed wing who could walk on, maybe 15-20% of our pt.s could be even somewhat considered stable.

Think we have different definitions of a air ambulance/medevac.

In Alberta tonnes of the patients are "Ambulatory", ie they walk on. The issue is that they have drugs running that require a paramedic. EMT's can't supervise the patient with these drugs running and very few of the rural EMS companies have Paramedics. Most have bare bones EMT's and EMR's. An EMT can start an IV, take blood pressure, and use an AED. No offence to them but it's about a 6 week course to become an EMT. Air ambulance companies all have Paramedics (2 years of training) and can bring doctors, nurses, RT's, baby teams, etc if required.

The next issue is the cost of time. Let's say Ft Mac EMS has a paramedic and EMT they can send to Edmonton with a stable patient transfer who has a nitro drip, or are intubated, or a whole host of hypothetical cases. The drive basically takes all day and then they need to stay the night in a hotel, and then drive back, 2 days they are gone and have to be covered, vs an air amb crew 4 hour out and back.

Lots of the work is not critical care but is the cornerstone of our medical system, which says that all Canadians have the right to the same level of care regardless of where they live.

[ThatArmyGuy]

We've talked a lot about Alberta's air medevac. It would be interesting to hear other's thoughts on ambulatory vs litter patients, trauma vs stabilized patients throughout: the Maritimes, ON, SK, and MB.

I presume SK and MB's medevac scheme is similar to ours here in AB.

[bobcaygeon]

Ummm not really!!!! Look at a map.

Most of Manitoba has no roads with many fly-in only towns and reserves so you need a plane ride for a regular doctor visit never mind a medevac.

Alberta has Ft. Chip....