It might seem that the aviation and air ambulance companies have little in common. While one deals in the mechanics of aviation machines, the other primarily deals with biology and chemistry of the human body. However, when one looks closely, it is easy to spot several similarities between the two. It is these similarities that the air ambulance companies must be aware of and must work on, to improve the safety of medical flights. The risks involved in both industries are very similar to each other. This is why REVA, which is an international fixed-wing air ambulance company, has published a white paper on ‘Just Culture’
What is ‘Just Culture’ and How Does it Apply to Air Ambulance Companies?
This is a highly relevant question. Although one rarely gets to hear about fatal crashes and safety flaws concerning air ambulance companies, such incidents are not unheard of. Apart from this, there are obviously going to be some near misses. The logic behind the ‘Just Culture’ is to treat mistakes as learning opportunities to avoid them completely in the future. REVA released a white paper on the topic recently.
According to Emma Roberts who is the company’s Safety Director, the white paper meant for air ambulance companies, lays down the steps involved in implementation of just culture and explains how this culture increases the degree of safety.
‘Just Culture’ Fosters Transparency in the Way Air Ambulance Companies Function
‘Just Culture’ makes reporting easier for staff who constantly put their lives on the line to protect and serve the needy patients. The culture ensures that these front-line warriors are not punished for the mishaps but are rather encouraged to report them so that apt solutions can be found. The result is improved safety of medical flights and better compliance with medical as well as aviation norms.
The word, Korea, brings to mind the latest development between the two nations – one a proponent of democracy and the other a dictatorship. What most people do not know is that Korea, as a whole, had a huge part to play in the evolution of medical air services. It all began during the Korean conflict in the 50’s of the last century. Making way in the conflict-ridden zone was no joke, owing to the bad reach and wartime danger. What came handy was a modified chopper that could carry patients to the nearest medical base, just in time to save life or at least salvage a limb.
The Idea of Medical Air Services Took Off
The success of the modified aircraft to serve as an air ambulance was a great success. This inspired the military to dedicate choppers for this very purpose. It is believed that over 20 thousand soldiers were rescued using military medical air services. However, owing to the technology and limited logistics of the time, the concept did not make its way to civilian lives for quite some time. Medical air services got further military acceptance when over 80 thousand soldiers benefited from them during the Vietnam War. All the wars from the time of the Second World War had seen medical air services evolve.
The Foothold into Civilian Lives
The mid 1960’s saw a path-changing societal research paper titled, “Accidental Death and Disability.” It questioned the fundamental logic behind limiting medical air services for military use. It brought to light how air ambulances can be of immense help to save civilian lives during medical emergencies ranging from motor vehicle accidents to cardiac arrests. By this time, aviation logistics had also evolved greatly. The result: first medical air service saw the day of light in the United States in 1972. By the turn of the century, over 203 thousand people were benefiting from medical air services.
Over the past few years, the medical flight services have steadily risen in cost, so much so that the cost has gone up at a whopping 5% per annum since almost the past 7 years. There have been concerted efforts on the part of state governments and the federal government to bring the cost of medical flight services down, at least to a ‘reasonable’ level. However, the definition of what is reasonable has been rather loose. In the midst of all this, it is natural that people in general are concerned about workers’ compensation and how it deals with medical flight services.
Handling of Medical Flight Services by Workers’ Comp
The big concern of most people is naturally whether they have to pay out of pocket in the eventuality that medical flight services are utilized for a work-related injury. Many would simply ask whether there is a possibility of a balance payment being demanded.
Such worries, however, have no basis to them. The amount would be settled by the insurance carrier and if the amount being approved by the carrier is less than what the air ambulance company is claiming, the victim of the accident need not be concerned. It is up to the medical flight services company and the carrier to come to a settlement. In most cases, the air ambulance company gives the insurance carrier a discount.
The Clash of Two Laws and the Way Out
Most states have fee schedules that define the extent of medical flight services cost coverage. However, ADA or Airlines Deregulation Act of 1978 allows air ambulance service providers to charge what they feel is reasonable without any questions being raised. The two laws can be, sometimes, contradictory to each other. However, in spite of all this, it still boils down to the air ambulance company and the insurance provider coming to a common monitory agreement, in case there is a dispute.
More often than not, we hear about skyrocketing medical flight bills that families are forced to pay. While it is natural for such families to feel victimized, having some prior knowledge about insurance coverage can prove helpful. If you are among those people who feel all they need to do is pay health insurance premiums, sit back and relax, here’s some news: your most basic health needs might not be covered. This mostly happens when the medical service provider is out of network.
Out of Network Medical Flights can Be Expensive
Take the case of 8-year-old Ben Millheim who met with an unfortunate accident fracturing his skull. The injury necessitated using a medical flight service to a hospital about 100 miles from the site of injury. While the boy survived and recovered well, his parents are still reeling under the $32,000 medical flight bill. Unfortunately for them, the medical flight service that they had used was out of their insurance network. As a result they are now liable to pay the service provider the ‘balance bill.’ In other words, they have to now shell out of their pockets the amount that their insurance provider has refused to pay the medical flight company for the reason that it does not come in their network.
It’s Almost Always a No-win Situation for Patients
Life-threatening injuries leave little room for checking whether a particular medical flight service provider is covered by the health insurance. While insurance companies flatly refuse to bear such expenses, it has been seen that air ambulance companies usually offer a discount to such patients. Plus, several states in the United States have passed legislation to limit balance billing; however, some states like Missouri have not. It must also be noted that there is no federal regulation that governs balance billing, leaving people vulnerable.
You may have invested in the best EMS software available in the market to maintain your patient records. However, that doesn’t guarantee that your air ambulance service will maintain flawless patient care records. There are several steps that managers need to take that will ensure that your team maintains better data using the equipment and resources you have.
Prioritizing on Training New Air Ambulance Service Hires
When orienting new employees to the service, make sure you include a course that thoroughly covers writing patient care reporting. You should train them on how to input data accurately and pertinently in addition to teaching them how to use your PCR software.
But that’s not enough. Your employees should have a clear understanding of why it’s important to maintain accurate and complete patient care reports. So you should include a few sessions that will help them understand how the quality of their data collection procedure also affects your air ambulance service.
Have Regular Audits throughout the Organization
It’s also crucial that you try to have regular audits throughout your organization to ensure that your employees are complying with your rules and requirements. You should thoroughly go through the patient reports created by each of your employees every few months. And make sure you try to see their reports from different months to ensure that they are being consistent with the quality.
Regular audits of your patient care reports will also help you identify scopes for improving your current process. For example, maybe you have noticed that the report only has the name of the person entering the report. And you think that it would be better to record which of your employees were tending to the patient. So you’ve decided that you should change the report in such a way that everyone’s name is listed.
If you’re reading this article, chances are that you’re interested in joining the air ambulance industry. And perhaps you wish to provide life-saving care by becoming an air ambulance transport paramedic. Maybe you’re still considering the option and are unsure whether the job would be a good fit for you. Here are some of the best reasons why you should become an air ambulance paramedic:
Reason 1: You won’t be working behind a desk
For those of you who have been dreading the idea of working in a corporate white-collar job with your own cubicle, becoming an air ambulance paramedic has great appeal. It’s not monotonous like your typical office job and you’re always on the move.
Reason 2: There’s a high demand for air ambulance transport paramedics
If you’ve ever worried about being unable to land a job in the field of your choice, you wouldn’t have to face those worries if you become an air ambulance paramedic. The air ambulance industry is growing exponentially, and therefore has an increasing demand for experienced paramedics.
Reason 3: Experience better salary growth than ground EMTs
There’s been a growth in the salary graph of paramedics in the air ambulance industry. While the average salary stood at $34,360, some states have an average salary of $54,180 for air ambulance paramedics.
Reason 4: You can build your self-confidence
The role of an air ambulance transport paramedic requires you to be self assured and to trust in yourself. As a result of these demands, you get to build your self-confidence that will help you in your personal and professional life.
Reason 5: You get to make a difference
As an air ambulance paramedic, there may be times when you encounter patients who are so seriously ill or injured that they don’t end up surviving even if you did your best. But in many cases, you are the difference between life and death for your patients. And you can make a difference for them, which is the most important reason you should build a career in air ambulance paramedicine.
In a previous post, we talked about some of the specific guidelines you need to follow when treating patients who have fainted. Also known as syncope, fainting is a common occurrence and as a medical flight paramedic, you may encounter a few patients in this situation. In this post, you’ll get more details about the guidelines released by the American College of Cardiology so you can get a thorough understanding of what to do.
More tips on handling medical flight patients with syncope
The previous post talked about the initial steps you need to take when you encounter a patient who has fainted. And those steps can be used by medical flight paramedics. According to the American College of Cardiology, health care professionals can follow the guidelines below when they have to treat a patient who faints:
- Some patients may have fainted because of irregular heartbeats, which can even be life-threatening. To determine whether your patient is facing this issue, doctors can use an implantable cardioverter-defibrillator to regulate the heartbeats.
- For syncope patients who have heart conditions, beta-blockers can be a good option.
- Health care providers should advise fainting patients to restrict their exercise in the future.
- Patients with recurring fainting spells resulting from very low heart rate might require pacemakers. In case of patients with common faints, drugs may be enough to control the situation.
- In case of unexplained fainting, heart rhythm monitoring is a good option to determine whether or not the patient has intermittent heart rhythm issues resulting in fainting.
The American College of Cardiology also advises athletes with fainting issues to visit an experienced health care provider for a heart assessment. These are some of the basic guidelines that can help in providing the right level of care for people who faint.
An associate degree or a certificate with the relevant certification and training is usually enough for a person to qualify as an air ambulance paramedic. And people who do hold this position are highly-trained and professional. They have the expertise and the knowledge required to carry out their duties. But having a higher education is ideal to secure your job as a paramedic for an air ambulance service.
Benefits of Higher Education to Work for an Air Ambulance Service
There are many air ambulance paramedics out there who are perfectly capable of carrying out their duties despite only fulfilling the minimum education requirement. However, a higher education is ideal to better perform your duties because of the following reasons:
- Better comprehension – In your training to become an air ambulance paramedic, you will be covering plenty of text books and course books to help you learn the basics. And when you have a higher degree, there’s a better chance of you understanding what these books are saying. Although most paramedic students will be able to read the books, students who have a low grade level reading skill might find it more challenging to comprehend the study course.
- Better ability to make rational decision – Being a paramedic for an air ambulance service requires rational thinking, which will lead to rational decision making. For this, you need to train your brain to logically work through difficult situations and problems.
Courses in math and accounting can help with this and if you have a higher education, it’s likely that you would have gotten through such courses. So you will be able to easily make accurate drug calculations, time and distance calculations, etc.
- Better ability to handle complexities in paramedicine – A higher education also improves your chances of understanding changes and revolutions in paramedicine. It could help you gain a better understanding of complex pathophysiology, anatomy, and physiology.
If you have Medicare coverage, you can get coverage for ambulance transportation to or from the hospital. The coverage also includes skilled nursing facility (SNF) or critical access hospital (CAH). It’s important to remember that Medicare will help you pay for ambulance services but only if other modes of transportation could be harmful for your health. This doesn’t necessarily mean you automatically quality for air ambulance transport either. First, let’s take a look at the medical necessity of availing ambulance transport.
Medical Requirement for Availing Ambulance Transport Under Medicare
Medicare will pay for the cost of emergency ambulance transportation in case of sudden medical emergencies with your health being in serious danger, provided that other modes of transportation like cars and taxi could endanger your health. You can get coverage for ambulance transportation if:
- You’re unconscious
- You’re bleeding heavily
- You’re in shock
- You require skilled medical treatment throughout the transportation
Requirements to Qualify for Air Ambulance Transport Under Medicare
The above-mentioned examples don’t necessarily qualify you fir air ambulance transport that is covered by Medicare. To be eligible for medical transport by air, your condition must require immediate and fast transportation that cannot be done through ground transportation. Medicare will cover for your expenses only if your condition fulfills the following requirements:
- Ground transportation can’t easily reach your location
- Obstacles like heavy traffic, long distances, etc. could prevent you from getting the immediate care that you require if you’re traveling by ground ambulance
There may even be a few but special instances wherein Medicare will cover for the cost of ambulance transport even in non-emergency cases. This is provided in case you have a doctor’s letter stating that your medical condition requires transportation with an ambulance.
Contrary to popular belief, hospitals are rarely involved in dispatch of a medical flight. The decision is almost entirely taken by the ground crew and treating doctor who determine whether the patient would benefit from an air ambulance service or not. Of course, there are some protocols that are followed. Although the process and protocols vary depending on the jurisdiction, there are certain common determinants that we discuss here.
Time Taken for Medical Flight Dispatch
It must be understood that not all hospitals have a medical flight on standby. It takes a reasonable amount of time to get the flight ready for takeoff. If this time and the time required to transport the patient is too much when compared to ground ambulance transport, the latter may be chosen. There is also a cost consideration when the difference in time advantage is too small.
Location and Distance of Transfer
This is another important criterion. Sometimes the location is too far away from the hospital and the patient’s health does not permit long travel times. Also, the location may be inaccessible through roads. In circumstances like these, the decision is usually made to opt for a medical flight to keep the patient safe.
The Condition of the Patient
This is of extreme importance. A delay by half an hour can mean the difference between life and death for the patient. In scenarios like these, a decision is taken quickly to call for an air ambulance and the patient is transported. Near-drowning, prior history or suspected stroke, and severe trauma could be some of the conditions that could influence the decision.
The Weather Conditions for the Medical Flight
If there are adverse weather conditions that prevent the choppers from flying, the patient may be transported through other means. As a matter of policy, the lives of crew members are not put to risk knowing very well that taking off in bad weather could be fatal.
It is important to understand that the above are just a few of the reasons that influence medical flight dispatch decisions. It is always the competent medical authority that takes the final decision.