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Helicopter Medical Transport Service: The authors reply
letters Helicopter Medical Transport Service
With regard to cost, the transport of patients by rotor wing aircraft to tertiary-care hospitals is an Despite the remarkable detail presented by Farnell expensive proposition. An average flight incurs about and Sachs in their recent article on the Mayo Clinic's $2,500 in actual cost, whereas the average charge to helicopter emergency transport service (Mayo Clin the patient in the north central United States in a 4 Proc 64: 1213-1225, 1989), the authors did not discuss 1989 survey was $1,354. This discrepancy in charges the cost of the program or provide data showing versus actual cost has its roots in the short history of improvements in morbidity and mortality that would aeromedical transport. The first such program in the United States was begun only some 18 years ago, and justify its expense. Without attention to these areas, any evaluation the fee structure was set at a level commensurate of the helicopter transport service is incomplete. with that of land-based ambulances. No data were Could the authors provide us with information on available at that time to suggest that this mode of the program's cost and its effects on morbidity and prehospital transport conferred advantages beyond that oftraditional patient transport methods. Fortumortality? nately, as studies such as the aforementioned ones Alan L. Cowles, M.D., Ph.D. were published, the advantages of aeromedical transport have become clearer and have helped to add Overland Park, Kansas justification for charging appropriately for a service that hitherto has been undervalued. Currently, the charge-to-cost ratio for aeromedical transport is The authors reply approaching unity in many programs nationwide. In summary, it is clear that although hospitalWe thank Dr. Cowles for his interest and will attempt based transport programs are extremely expensive, to respond to his questions about program cost and they do play an important role in the prehospital and the effect of air medical transport on morbidity and interhospital care of critically ill patients, current mortality. The latter will be addressed first. evidence suggesting a decline in mortality for victims Although our study was not designed to examine of trauma. Additional studies should be undertaken differences in morbidity and mortality rates for pa- for all categories of patients in an effort to identify tients transported by ground in comparison with those who are ideal candidates for air transport. those transported by air, some investigators have done so. Case control studies comparing trauma Michael B. Farnell, M.D. patients transported by helicopter with those transJanet L. Sachs, R.N. ported by land ambulance, when stratified on the basis of severity of injury, have shown improved survival for the group transported by air. 1-3 Of note, REFERENCES the time intervals from injury to arrival at a trauma 1. Baxt WG, Moody P, Cleveland HC, Fischer RP, Kyes FN, Leicht MJ, Rouch F, Wiest P: Hospital-based center in these reports were similar by land and by rotorcraft aeromedical emergency care services and air, and the important factor in improving outcome trauma mortality: a multicenter study. Ann Emerg seemed to be early delivery of highly skilled and Med 14:859-864, 1985 experienced personnel to the patient. Aeromedical 2. Baxt WG, Moody P: The impact of a rotorcraft aerotransport programs have, in effect, made the skills of medical emergency care service on trauma mortality. JAMA 249:3047-3051,1983 the level I trauma center available to a much wider area than would otherwise have been possible. This 3. Moylan JA, Fitzpatrick KT, Beyer AJ III, Georgiade GS: Factors improving survival in multisystem trauma advantage is particularly evident in a rural environpatients. Ann Surg 207:679-683, 1988 ment, where most prehospital providers are trained 4. 1989 transport charge survey. Hosp Aviat 8:19-20, at the basic life support level. June 1989 Mayo Clin Proc 65:436-438, 1990
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With regard to cost, the transport of patients by rotor wing aircraft to tertiary-care hospitals is an Despite the remarkable detail presented by Farnell expensive proposition. An average flight incurs about and Sachs in their recent article on the Mayo Clinic's $2,500 in actual cost, whereas the average charge to helicopter emergency transport service (Mayo Clin the patient in the north central United States in a 4 Proc 64: 1213-1225, 1989), the authors did not discuss 1989 survey was $1,354. This discrepancy in charges the cost of the program or provide data showing versus actual cost has its roots in the short history of improvements in morbidity and mortality that would aeromedical transport. The first such program in the United States was begun only some 18 years ago, and justify its expense. Without attention to these areas, any evaluation the fee structure was set at a level commensurate of the helicopter transport service is incomplete. with that of land-based ambulances. No data were Could the authors provide us with information on available at that time to suggest that this mode of the program's cost and its effects on morbidity and prehospital transport conferred advantages beyond that oftraditional patient transport methods. Fortumortality? nately, as studies such as the aforementioned ones Alan L. Cowles, M.D., Ph.D. were published, the advantages of aeromedical transport have become clearer and have helped to add Overland Park, Kansas justification for charging appropriately for a service that hitherto has been undervalued. Currently, the charge-to-cost ratio for aeromedical transport is The authors reply approaching unity in many programs nationwide. In summary, it is clear that although hospitalWe thank Dr. Cowles for his interest and will attempt based transport programs are extremely expensive, to respond to his questions about program cost and they do play an important role in the prehospital and the effect of air medical transport on morbidity and interhospital care of critically ill patients, current mortality. The latter will be addressed first. evidence suggesting a decline in mortality for victims Although our study was not designed to examine of trauma. Additional studies should be undertaken differences in morbidity and mortality rates for pa- for all categories of patients in an effort to identify tients transported by ground in comparison with those who are ideal candidates for air transport. those transported by air, some investigators have done so. Case control studies comparing trauma Michael B. Farnell, M.D. patients transported by helicopter with those transJanet L. Sachs, R.N. ported by land ambulance, when stratified on the basis of severity of injury, have shown improved survival for the group transported by air. 1-3 Of note, REFERENCES the time intervals from injury to arrival at a trauma 1. Baxt WG, Moody P, Cleveland HC, Fischer RP, Kyes FN, Leicht MJ, Rouch F, Wiest P: Hospital-based center in these reports were similar by land and by rotorcraft aeromedical emergency care services and air, and the important factor in improving outcome trauma mortality: a multicenter study. Ann Emerg seemed to be early delivery of highly skilled and Med 14:859-864, 1985 experienced personnel to the patient. Aeromedical 2. Baxt WG, Moody P: The impact of a rotorcraft aerotransport programs have, in effect, made the skills of medical emergency care service on trauma mortality. JAMA 249:3047-3051,1983 the level I trauma center available to a much wider area than would otherwise have been possible. This 3. Moylan JA, Fitzpatrick KT, Beyer AJ III, Georgiade GS: Factors improving survival in multisystem trauma advantage is particularly evident in a rural environpatients. Ann Surg 207:679-683, 1988 ment, where most prehospital providers are trained 4. 1989 transport charge survey. Hosp Aviat 8:19-20, at the basic life support level. June 1989 Mayo Clin Proc 65:436-438, 1990
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