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Air Ambulance Medicine: Accessing the Future of Health Care

A Public Policy Paper by the MedEvac Foundation International.

Air Ambulance Medical Services Summary

The use of air medical services (AMS) has become an essential component of the health care system. Appropriately used air medical critical care transport saves lives and reduces the cost of health care. It does so by minimizing the time the critically injured and ill spend out of a hospital, by bringing more medical capabilities to the patient than are normally provided by ground emergency medical services, and by quickly getting the patient to the right specialty care.

Dedicated medical helicopters and fixed wing aircraft are mobile flying emergency intensive care units deployed at a moment’s notice to patients whose lives depend on rapid care and transport. While AMS may appear to be expensive on a single-case basis compared with ground ambulance service, examining the benefits behind the cost on an individual and a system-wide basis shows that it is cost-effective. The picture of a helicopter at the scene of a car crash evokes visions not only of the life-saving power of air medical services, but also of the risks of the environment into which they fly. Yet, air medical patient care and transportation actually promises less risk to the patient than does a patient’s hospital stay. “Time is human tissue” is a saying that means death and disability from severe injuries, heart attacks, strokes, medical and surgical complications, and other time-dependent conditions often can be avoided if the right care is provided quickly enough.

AMS is a means to bridge geography and time. As technology provides new, time-sensitive care, the need for AMS will increase. As the costs of the health care system continue to rise, and the availability of even routine health care in rural communities is put at risk, AMS will play an increasingly important role in the delivery of health care. In these days of increased concern about homeland security and emergency preparedness, air medical services provide a valuable medical resource that can transport patients and medical staff long distances, as well as carry medical equipment and medical supplies to the affected area(s). AMS is an integral component of disaster planning and management. The recent experience of hurricanes Ivan, Katrina, and Rita illustrate the essential role of AMS in evacuating critically ill and injured infants and adults from hospitals and nursing facilities as well as providing direct scene support to disaster management teams. Without a prompt and massive AMS response of both dedicated air medical helicopters and fixed wing aircraft to the Gulf Coast, thousands of additional lives would have been placed at risk or even lost. Integrated air medical resources are an essential component of contemporary EMS systems.

Today, financial pressures, insurance issues, changing federal regulations, and competition all are forcing changes, consolidation, and in many cases reduced services or closure of emergency departments, trauma centers, hospitals and specialty physicians. These factors have contributed to the increased use of AMS to move patients to specialty centers, particularly from outlying areas. As with EMS in general, there has been a general lack of overall system planning and design to guide the development and implementation of needed AMS. Mechanisms that might provide such guidance, such as state EMS or health regulations, certificate of need (CON) processes, and federal aviation and healthcare regulations sometimes conflict with one another, providing a jumble of uncoordinated hurdles to AMS providers.

The future of Air Ambulance Services

Maintaining access to care is an ever greater challenge for both healthcare providers and policy makers. Natural and man made disasters have highlighted the need for an effective, available air medical system. This was exemplified in the air medical response to victims of Hurricane Katrina in which thousands of lives were saved during both scene response and the evacuation of critically ill patients from hospitals. air ambulance service has been shown to be cost-effective when looking at total medical costs as well as lives saved.

Much like other effective healthcare interventions (such as trauma systems), technologies (such as CAT scans), and specialty surgeries (such as those for heart attacks patients), air ambulance service is expensive to maintain. It is essential that public policy and funding sustain air ambulance service as a critical part of the medical and emergency preparedness safety net in our communities. Maintaining the readiness to respond is as essential as the actual care delivered by air ambulance service.

According to the US Department of Health and Human Services, “It was estimated that in 2000 there were 605 million persons worldwide aged 60 years or older. This number is projected to increase to almost two billion by 2050.”  The trend is particularly noticeable in the U.S., with a rapidly aging population, especially in rural areas. The emergency medical needs of this population are reflected in the growing rates of trauma, as well as the increased occurrence of time-critical conditions such as heart attack, stroke, and non-trauma surgical emergencies (e.g. abdominal aneurysms and stomach/intestinal bleeding).

Recent studies examining the response to elderly trauma patients have found that many of these patients do not currently reach trauma centers in a timely manner.  As medical science creates new ways to intervene in medical emergencies with technology that must be utilized within a critical window of time, the need for air medical services to bring that technology to patients, or to bring patients to that technology, will increase.

Current financial pressures on the health care system will only increase. The mismatch between demand and resource availability is becoming more acute. These pressures will continue to erode the availability of hospital based delivery of specialty care and life-saving technologies, particularly in rural areas. The need for increased access to ever scarcer specialty care resources, and the increased need to make such care mobile will increase the need for air ambulance service.

The Flying Doctor Service in Australia is one successful model of providing both emergency and routine medical services by air to far-flung populations. The Association of Air Medical Services believes that it is essential to assure that every person has access to quality air medical and critical care transport when needed. It is imperative that policy and funding support the availability and sustainability of air ambulance service to every community.