Air ambulance operations are always critical. Among the critical operational aspects of a medical flight is handing off of the patient between medical flights and ground ambulances. If not done properly, it can lead to increased cost, loss of time and unnecessary lock down of valuable human resources. The efficiency at this juncture is all the more important because, usually, people from two different organizations have to come together to ensure a seamless transfer of the patient. In the event that each company has its own set of guidelines and procedures, things can get a bit complicated. It is for this reason that the Centers for Disease Control suggests a common methodology. Here we take a brief look at it.
The Planning of Hand Off between Ground and Air Ambulance
- Plan is the first thing that is to be put in place. It covers notifying each other of all developments. Beyond the ambulance companies, other organizations such as public health authority and law enforcement agency too might need to be notified.
- Communication of important aspects is another issue that must be taken care of – Does the patient have an infection? Is he or she ambulatory? Is there any special medical need? These are some of the questions, the answers to which both parties must have for communication to be effective.
- Location should be carefully chosen. It is not always about the nearest one. The patient may be a carrier of a highly infective virus. In a situation like this, the landing location should be such that the people in general can be easily isolated. The staff too must be aware that proper care should be taken to keep them from harm’s way. Adverse weather conditions are also important determinants of location. Media too can be an issue when it is a matter of national concern and can lead to a panic-like situation if information flow is not controlled.
There are several other aspects that must be taken care of. We will continue to focus on this subject in the coming days.
Air ambulance services play a critical part in providing medical care on time for stroke victims. The Centers for Disease Control estimates that about 795 thousand people suffer strokes every year in the United States of America. Up to 140 thousand of these people die of stroke. Approximately 610 thousand people have never experienced stroke before. To put these numbers into perspective, one person has a stroke every 40 seconds on average in the country. All these people need air ambulance services to receive care on time. If not, they are at risk of suffering disability for the rest of their life.
Air Ambulance Services are Time Critical in Stroke
It is said that the chances of survival and complete recovery improve drastically if the patient receives care within the first three hours of the stroke. Air ambulance services play a major role in ensuring that this. The fact that rural doctors are moving towards urban areas and the reality that rural hospitals are closing at a rapid rate makes air ambulance services for such regions critical and life-saving. These patients are in need of high-level care facilities equipped to handle this medical condition.
The Economics of Stroke
In the US, cost of stroke treatment is approximately USD 34 billion annually. This includes the cost of care, medicines and loss of work revenue due to medical absence. Despite this, insurances only cover about 30 to 40% of the cost related to air ambulance services. Why? Because the reimbursement rates have not been revised for over 20 years, which puts a lot of financial strain on air ambulance services. The result – medical flight service providers are closing at a rapid rate, especially in rural America. If something is not done about this by the congress, it could turn out to be a grave situation for the people in the near future.
Perhaps the biggest problem that people who avail medical air transportation services face is unexpected costs that run into thousands of dollars, even when they are covered by their health insurance policies. Now, a new bill has been passed by the state of Virginia that seeks to end this uncertainty. The bill is called ‘Air Medical Transportation; Informed Decision’. The bill was introduced by Jeremy S. McPike and it went into effect on March 1, 2019. It was passed by the House and Senate of Virginia with zero votes against it recently. Here, we discuss what this bill will mean for the common citizens.
What is Virginia Medical Air Transportation Bill All About?
The bill mandates that hospitals establish processes, which necessitate giving an electronic or written notice to the patients or their authorized representatives. The notice should contain the cost implications of availing medical air transportation services. It should also contain the alternative options including emergency ground ambulance options. If the medical air transportation is out of network of the patient’s health insurance, this fact too must be made apparent. Even if the medical air transportation is covered only in part, it has to be brought to the attention of the patient or his/her authorized representative.
What will the New Bill will do for the Patients?
Patients in Virginia will now have the power to choose whether they want to avail medical air transportation services. Further, it will let them know the cost implications beforehand so that they do not get any nasty surprises in the form of huge bills later on. It is a good attempt by the state to bring about transparency in billing.
It is hoped that the medical insurance companies and the medical air transportation industry will ultimately come to an understanding with regards to costs, facilitated by this bill.
The medical flight industry is highly competitive with hundreds of organizations offering this emergency service around the world. With insurance companies not always covering the full cost of the medical flights and people being wary of the high price involved, the question that is being contemplated is whether lowering the standards of service within the legal realm a viable option. Among the cost factors are maintenance, fuel, hangars, and staff. While the first three are almost impossible to control, staffing is something that most are looking at. Here are a few things that some medical flight providers around the world are considering according to a recent survey by ITIJ.
Cutting Down Medical Flight Staffing and Training Costs
Of course, the more experienced professionals such as doctors, nurses, paramedics and pilots come at a huge cost. But then, there are low-cost medical flight service providers who lower their standards when it comes to hiring standards. It must be noted in this regard that staffing is among the highest recurring expense for most companies.
Training can be expensive too. In order to maintain accreditations, constant training programs need to be held and medical flight companies must make way for the accreditation agencies to evaluate them. All these activities can push the costs high. Doing away with accreditations can cut the cost to some extent and this is among the reasons why several medical flight service providers veer away from them.
Containing the Cost of Equipment
The medical flight industry is constantly evolving, especially when it comes to technology. Using outdated equipment that is still legally acceptable is a choice that many air ambulance companies are contemplating today.
The question that one must ask in this context is whether this is the right path to take. People are entitled to best care possible at reasonable costs. How this can be achieved is a question that only future will tell.
The common assumption, most often, is that a patient is always flow to the nearest treating facility when an air ambulance is employed. However, this is not always true, although the nearest facility is taken into consideration owing to the cost as the nearest one would obviously cost the minimum. What people need to understand is that air ambulance is a live-saving service and not a cost-saving service. The primary criterion is therefore not just the nearest but also the most appropriate treating facility. For instance, a burn victim may be carried by the air ambulance to the nearest burn care center, although a highly specialized trauma care is just a few blocks away. Again, the primary intent here is to save lives.
Other Considerations taken Into Account by Air Ambulance
The paramedics have a huge say in deciding the treating facility. Of course, they cannot suggest any specific hospital as this would give a leeway for bias but they can specify the kind of facility that the patient should be flown to. Typically, the choice is between the following during medical emergencies:
- Trauma Centers
- Burn Centers
- Cardiac Care Centers
- Stroke Centers
- Pediatric Hospitals
What Happens When a Patient is Involved in a Multi-Casualty Incident?
Natural disasters, for instance, can result in multiple people in need of urgent care. In cases like these, it is impossible for one hospital to take care of all the incoming casualties, no matter how close it is to the incident. An air ambulance in such a situation will look for appropriate facilities, regardless of the distance.
Does Patient Choice Come into Picture?
There might be instances where your health insurance covers you in one particular hospital but not the other; it is fair to request the air ambulance service provider in such instances to fly you to the one that will not affect your coverage. However, one has to mindful whether the cost of air ambulance service, in such cases, is covered or not. It is wise to consult your case worker in a situation like this.
We have been citing the reluctance of insurance companies to revise their payment charts, in keeping with the time and also several air ambulance companies that simply refuse to budge down when it comes to the pricing.
This time around, Missouri Insurance Department has come up with a report that reveals, on an average, people of Missouri are paying about USD 20,000 for an air ambulance services. Of course, this is a whopping price for a common person, not just in the state but anywhere in the world. The report further said that close to USD 26 million was billed by air ambulance companies in the year 2017. Of this, 12.4 million is what people had to bear, taking into consideration deductibles and co-pays.
Does the Report Vilify Air Ambulance Companies?
This was a question that air ambulance industry advocates would raise without a doubt and not for any frivolous reasons. Balance Billing, which forces patients to pay the amount when insurance companies refuse to clear the air ambulance bills, had no mention in the report. The reason stated for this was ‘insufficient data’. One could even say that the lack of this data, sort of makes the report a little lopsided.
High Fixed Cost was Cited by Air Ambulance Companies
One aspect that should be appreciated about the air ambulance companies is that they have not shied away from saying the amounts charged to the patients are pretty steep. They have also expressed their helplessness in containing this, as the fixed costs of maintaining a medical flight is very high. However, what goes against the favor of some air ambulance companies is the fact that they are unwilling to come in the network of insurance providers.
As we have always stated, the air ambulance industry and the insurance industry need to come together to find a middle path, so that the common person does not have to bear the burden of huge bills.
It has almost become a norm to blame organizations that offer medical flight services but not many people take the time or the effort to understand why they charge so steeply. While it cannot be denied that there is a definite profit motive as these are commercially operated organizations, there is more to their expenses than what meets the eye. The costs are not simply limited to the fuel that is utilized, there are far wider factors in play that push the costs up and we explore some of these.
The Major Expenses that All Medical Flight Services Must Meet
Typically, an air ambulance does not undertake more than three missions in a day. For the rest of the time, this highly expensive machine is simply forced to sit idle. Moreover, it does not fly a single mission several days in a year. While this is a fact, the cost of the funds raised to acquire it continues to compound. Same is the case with the base; medical flight services need a place to park the choppers and fixed-wing aircrafts throughout the year and the rent is, obviously, an added cost that needs to be borne.
The Expenses of Maintaining a Highly Qualified Team
Highly experienced pilots, paramedics, nurses and the technicians are just some of the staff members that medical flight services need to hire. Then, there are support staff, operational staff and the management staff too.
Utmost care is taken to ensure that the crew is properly rested. This translates into stipulated work hours regardless of there being a call for medical flight services or not. Of course, many of the crew members also take care of other duties while the air ambulance is docked; nevertheless, it is an expensive affair. Constant upgrades and training are other sources of expense, not to forget the expenses of remaining compliant with ever-changing regulations.
Psychosis can be a real problem for air ambulance professionals as they try to offer the best possible care during transport. Most often, specialists are relied upon to care for such patients during air ambulance travel. However, there are often cases where psychosis is simply a result of the situation that the patient is in and not necessarily a pre-existing condition. Therefore, the air ambulance professionals do not necessarily have any means to expect a situation like this. The reasons for the condition may be several and the response can vary from case to case. We look at some of such scenarios and discuss the best way to handle them.
Drug-Induced Psychosis on Air Ambulance
Crystal meth, cocaine, and a few designer drugs can induce severe psychosis in patients where they exhibit paranoid and panicky behaviour. The first course of action in such cases is administration of an antipsychotic drug. Restraints are not usually necessary unless the patient needs immediate IV medication. In such cases, a mild manual restraint is, most often, enough. However, unexpected display of physical strength during psychosis can warrant more effective and long- lasting restraints until hospital care is made available. The air ambulance professionals, in such instances, must ensure that the pulmonary function of the patient is not compromised in any way owing to the restraints.
Handing Patients with Pre-existing Mental Ailments
An example would be a schizophrenic who might need both medications and restraints to ensure smooth air ambulance travel. Usually, a qualified medical professional accompanies the patient in such situations. Then, there are also those patients who suffer from mild psychosis. The first approach to handle them is simply soothing words. Keeping such patients calm is often a matter of saying the right thing. Accompanying family members who know how to handle the patient are a huge help in cases like these.
The life of medical flight professionals can be quite adrenaline pumped most of the time but that does not preclude them from the responsibilities that come with being a part of the air ambulance industry. The training, the safety measures and the need to be on the call all the time are just some of the tasks that they are expected to undertake. Of course, the gratitude that they receive for saving lives is an additional bonus that perhaps every medical flight professional enjoys. Most people who become a part of the air ambulance industry very well know that they are stepping into a high stress job.
The Routine Tasks of Medical Flight Professionals
While the pilot is expected to run routine checks to keep the chopper health up, the medical flight crew members are required to ensure that all inventory and medical equipment are in place, the batteries are all charged up and basically ensure that all equipments are working fine so that they can effectively respond to emergencies. The station duties can range from keeping a tab on the blood fridge and logging fridge values to cleaning and taking out the trash. Each member assumes a responsibility when they are docked in the hangar.
Responding to Emergencies
While the medical flight professionals usually conduct several station duties, they subconsciously are always anticipating an emergency call. The moment it comes in, they are expected to leave everything and take up the duties that enable them to face the emergency effectively. They immediately do all that is needed to know about the patient health condition and equip the medical flight with all the necessities. The medical staff are alerted in the nearest appropriate hospital and logistics are quickly and efficiently taken care of. It should be noted that, in view of the fact that the entire routine is quite stressful, the crew is always allowed enough rest hours every day and are encouraged to get enough relaxation between shifts.
The questions that we discuss in this guide are primarily related to motor vehicle accidents. It must be noted that this is just a suggestive guide and only briefly looks into the various aspects that need to be covered when answering initial calls for airambulance dispatch. Most of the times, the calls are routed to airambulance service providers by emergency services. However, on rare occasions, calls may be made directly to the service providers. This guide may be helpful to an extent in situations like these.
Initial Questions to be Asked When a Request for Airambulance is Made
After a brief introduction and convincing the caller help is already on the way and that the call is in no way delaying the emergency response, attempts must be made to gain information regarding the motor vehicle accident victims. The caller should be asked whether he or she is still on the scene and whether the caller can see the patient. If the answer is negative, it is better to terminate the call and answer other calls pertaining to the same incident. However, if the answer comes in the positive, a different approach with a different set of questions must be followed.
The Subsequent Questions to be Asked
The person who calls the airambulance must be asked to quickly narrate what has transpired. Stock must be taken of the number of casualties and the caller must be asked where the patient is at the current time. Additionally, questions pertaining to the incident, in specific, must be asked. These could include the speed of the vehicle during the crash, the surface that the patient has fallen on, whether the patient is trapped, whether there are any burn injuries, etc. Apart from this, questions that are specific to the patient’s condition must be asked. These could be whether the patient is conscious and coherent, and whether the patient is breathing normally.
Questions like these will help you ascertain the seriousness of the situation and whether any ancillary services are required.