AircraftOwner Online

    Helicopter aeromedical transport began in Vietnam and was transitioned to the public section in the late 1970’s. The services quickly became flying billboards for competitive hospitals in urban areas even though the most important location for their use is in rural areas where transport times can be significantly reduced.

    However, accident experience over the past couple of decades has not been good with even a higher rate the past few years. The number of accidents has stimulated congressional investigations and numerous lawsuits. In addition, helicopter transport is more expensive than fix wing and astronomically more expensive than ground transport.

    But do they shorten the time of transport and improve the outcomes of patients? The studies do not support significantly decreased transport times except in rural areas where they are rarely located. Even more important: studies do not show that patient outcomes are improved with helicopter transports.

    When the University of Texas-Galveston discontinued it helicopter service, they found there was no difference in transport time and no increase in mortality for trauma patients. In Los Angeles, a study showed that 85% of pediatric trauma patients transported by helicopter were considered to have minor injuries and of the 189 patients transported, 33% were discharged from the emergency room without even being admitted to the hospital. In Pennsylvania in a very large study of over 160,000 patients, researchers did not find helicopter transport affected the odds of survival.

    Layer these statistics on top of the cost of aeromedical helicopter transport and one has to ponder the costs vs. benefits of many of the flights being taken. And all this is before we get to accident issues.

    Weather, darkness, pilot experience, crew fatigue, lack of knowledge of the landing sites, and varying terrain makes medical helicopter transport a risk taking operation. Add the emotion of a potentially critically ill or injured patient into the mix and chances appear to be taken that should not be. Unfortunately, this mix has been proven to be hazardous by the accident statistics on file.

    I worked with a physician assistant who ran an air ambulance operation and he insisted on calling the pilots “ambulance drivers.” He would tell his “drivers” the location of a patient, when the run was to occur and ask “Is it safe?” without telling them the severity of the situation. In this way, the pilots could truly judge the safety of the mission without the emotional overlay of the patient’s condition.

    This procedure maintained safety. Nothing can be worse than losing an aeromedical transport crew because of an unsafe operational decision. Isolation of the mission safety from the patient situation is critical for preventing accidents.

    Another issue is to avoid flying to produce numbers to justify an aeromedical transport systems existence. Many helicopter transfers between medical centers have no justification except for producing usage numbers. When the door to door time difference between an elective transfer by ground ambulance and a helicopter is measured in minutes, it is extremely hard to justify—especially when weather or darkness may be factors.

    The University of Pittsburgh Medical Center (UPMC) may have the medical transport system down the best. During a visit of their command center recently, I observed an integrated dispatch system which controlled both ground and air ambulances. This way, expertly trained personnel made rational decisions on the proper transport vehicles for patients for most of western Pennsylvania.

    UPMC’s safety record is superb and their billboards are bolted to the ground--which is the way helicopter aeromedical transport sytems should be.