Stocky,
I am reproducing the copy of an article from the Denver Post late last week. As you can see, the decision to send a helicopter vs an ambulance is a complex one. Standards are difficult to apply. Read the article and post what you think.
When's a chopper necessary?
By Ricky Young
Denver Post Transportation Writer
Dec. 21 - The South Santa Fe Drive pileup was only 4 miles from the nearest hospital, but Capt. Jeff Christ of the Littleton Fire Department called in a Columbia AirLife helicopter.
Christ's decision, one week ago tonight, turned out to be a fateful one.
The helicopter snagged power lines and crashed, killing the pilot, a patient and two nurses. But Christ said he can't second-guess the call.
"It's a great system," he said. "If it's my kid under a cement truck on C-470, I want a chopper called in. Speed is of the essence. I wouldn't hesitate to do it again." But officials say last Sunday's crash will inevitably raise questions about the wisdom of using airlifts in urban areas, where hospitals are a short drive away.
Insurance companies are increasingly balking at paying for the costly airlifts. And the grim memory of the crash might give ground crews pause next time helicopter transport is called for.
"That's human nature," said state medical director Dr. Steven Lowenstein. "It's a reminder of the risks as well as the benefits." Denver pioneered civilian air transport to hospitals in 1972, and the public has come to expect it as a life-saving option.
Sunday's four-car accident had nine injuries - two of them critical - and authorities didn't want to overload Columbia Swedish Medical Center in Englewood, the nearby hospital.
So Jerry DeHerrera of Englewood, the 23-year-old who police say caused the car wreck, was to be airlifted to Denver Health Medical Center. The patient had a pulse and some signs of life, but had only a few minutes, Christ said.
"His only chance was get in quick, crack his chest and open him up," Christ said.
Without second-guessing the ground crew, however, Lowenstein said questions about the system are healthy.
"It's customary, and vital, that we always ask these questions," he said. "In this case, it was felt to be needed because of the critical injuries and the multiple victims." Airlifts have the clear advantage of speed - 120 mph, compared to a safe ground ambulance speed of 60 mph.
The airlifts also can cover greater distances, allowing the diversion of some patients to hospitals farther away.
And they can bring high-tech equipment and better-trained health professionals to the scene of an accident.
Common sense seems to say that those benefits make the helicopter option vital.
But some experts say the issue is not that clear-cut.
"The underlying assumption is that you're reducing morbidity and mortality," said Robert Dodd, an aviation consultant and former researcher for the National Transportation Safety Board. "But nobody's been able to accomplish a scientifically valid comprehensive study where you look at airborne transport versus ground transport." Such numbers are particularly important, Dodd said, because airlifts can cost 10 times as much as an ambulance ride, and insurance companies are looking for ways to save money.
"It's not that air transport doesn't have a value," he said. "It's just that you can't quantify the value. The basic assumption is, faster is better. But how often is faster better?" There have been studies of the effectiveness of helicopter transport, but the results have varied widely. Some have shown that for every 100 airlifts, only one person survives who wouldn't have otherwise. Others indicate the number is as high as 12 people. Dodd says all those studies were flawed because of small sample size.
The industry has focused on making sure helicopters are called out when they are most needed. "These things are very expensive to operate," said Joel Harris of Flight Safety International in West Palm Beach, Fla. "Sometimes they're used when they shouldn't be, and that's not good ..." Three criteria are used when deciding whether to call an air ambulance, Lowenstein said.
First, is time critical, and will the helicopter save time? Second, are there multiple injuries that need to be spread to different emergency rooms in the area, so no one hospital is overwhelmed? And, finally, will the chopper with emergency room personnel and equipment help at the scene?
It appears, Lowenstein said, that all three criteria were met on Santa Fe Drive last weekend. Usually, he said, one affirmative answer justifies the helicopter call.
"The decision to dispatch a helicopter is never made carelessly or cavalierly," he said. "But it has to be made quickly. In this case, it was justifiable." |
