Category Archives: Medical

The Latest on Air Ambulance Transport Rules by FAA

The Federal Aviation Administration had laid down its groundbreaking safety rules for choppers in February of 2014, popularly known as the HAA (helicopter air ambulance) rule. It mandated that the choppers involved in emergency transport of the patient would have to meet requirements like:

  • Inclusion of certain specific safety instruments
  • Improved training and testing
  • Establishment of control systems for air ambulance transport vehicles

These were only a few requirements that were laid down. Although the initial deadline to meet these requirements was April 22 of last year, it was then extended by a year owing to the difficulties of the air ambulance transport companies to comply with them at such short notice. Most air ambulance transport companies have already complied with the first set of rules, although there is some anxiety in the air ambulance transport industry as the deadline nears.

The Air Ambulance Transport Sector will have to Meet More Deadlines

Although the air ambulance transport companies will have to comply with several of the rules laid down this year, there are some for which the sector still has time. Here’s a breakdown.

Compliance by April 2016: Setting up of operations control center.

Compliance by April 2017:

  • Installation of radio altimeters
  • Incorporation of warning systems and terrain indicators for choppers
  • Meeting qualification criteria for PIC instruments

Compliance by April 2018: Complying with mandated systems to monitor flight data.

Guidance is awaited by the Air Ambulance Transport Industry

The sources in the air ambulance transport industry revealed that it is not possible to comply with certain mandates unless there are clear guidelines by the FAA. Compliance with most of the rules will cost the air ambulance transport operators huge dollars, so obviously, they want to get it right and keep the expenses to a minimum.

For the pilots, crew and the people travelling in air ambulance transport vehicles, the rules will bring in more safety and efficiency. In general, the rules have been well accepted by the air ambulance transport industry so far.

Bed to Bed Air Ambulance Service – A Quick Guide

Bed to bed air ambulance services are often used when the patient is critical or needs constant medical attention throughout the transport. Essentially, the air ambulance service would coordinate the services such that the patient is under medical supervision throughout the duration of the transport, including transfer from hospital to the air ambulance and air ambulance to the receiving hospital.

How is Bed to Bed Air Ambulance Service Beneficial?

For one, the patient is constantly under the observation of medical experts. The staff that accompanies the patient is usually provided by a separate agency other than the transferring hospital. The knowledge exchange between medical experts about the patient becomes easier when a bed to bed air ambulance service is used.

The air ambulance staff also makes arrangements for ground ambulance in case there is a need to transport the patient by land from the airport to the receiving hospital. At the same time, the air ambulance service would ensure that all vital arrangements in the ground ambulance are ready. This effort also reduces the transit time. Moreover, due to constant communication, the ground staff would be aware of the patient condition at all times.

The same goes with the receiving hospital too. In other words, the condition of the patient can be constantly communicated to the receiving hospital and all necessary arrangements can be made beforehand. Such an arrangement puts the worries of the patient’s loved ones to rest for the most part.

Is Bed to Bed Air Ambulance Service Expensive?

It is slightly more expensive when compared to ground ambulance transport and a normal air ambulance transport where the patient is brought to the medical flight independently.

The fact that there is a lot of coordination involved with bed to bed air ambulance service increases the price a bit. However, one must realize that the ground ambulance coverage and air ambulance coverage are calculated separately by insurance companies and if the doctor has recommended such close monitoring, the chances are that the entire cost will be borne by the insurance provider.

Availing bed to bed air ambulance service is not a call that you must take on your own. The decision must be left to the qualified medical professionals as it is only then that this service is approved by insurance providers.

Is Air Ambulance Transport the Right Option? Answering these Questions Can Help

Deciding whether a patient needs air ambulance transport can be a tough decision, even for a doctor sometimes. In this realm, asking certain questions before deciding on air ambulance transport can help. Below are a few of them.

Does the condition warrant that patient spends least possible time out of hospital?

If the answer is yes, then the patient might be best suited for air ambulance transport as it is quicker than ground transport.

Is a time-sensitive facility unavailable in the current treating facility?

Certain lifesaving facilities or treatments might not be available in the hospital that is treating the patient at the current time. Air ambulance transport might become essential to carry the patient to the nearest medical center that has this facility.

Is the area only accessible through air ambulance transport?

Certain remote areas that have bad or no roads can only reached through air ambulance transport. Air ambulance choppers obviously are preferred during such cases.

Is the weather suitable for air ambulance transport?

The new FAA guidelines for air ambulance transport and the general safety concern for the crew prevents use of air ambulances when the weather conditions are unfavorable.

Is the weight of the patient, equipment and crew within permissible limit of air ambulance transport?

The permissibility of weight might also depend on the kind of aircraft that is available during the emergency. However, weight is a concern that must be addressed.

Is there an airport or helipad to land the air ambulance near the receiving facility?

If the landing facilities are not available, air ambulance transport might not at all be an option. Landing at a considerable distance and carrying the patient to the receiving facility through ground ambulance might defeat the purpose of using air ambulance transport.

Does the ground transport lack critical care support?

Air ambulances usually are extremely well equipped. If the ground ambulance lacks such support, then air ambulance transport might be the only option.

Will use of ground ambulance leave local area with inadequate emergency coverage?

If the answer is yes, then air medical transport might have to be opted so that the medical facility is prepared to meet other potential emergencies locally.

Answering these questions can help make split second decisions, which can mean the difference between life and death during emergencies.

Is Your US Air Ambulance in Accordance to Medicare Norms?

Understanding what constitutes an air ambulance according to Medicare is necessary. The fact ensures that you get into an aircraft that is equipped enough to take care of you or your loved ones. According to “Medicare Benefit Policy Manual,” the air ambulance needs to be equipped and designed such that it can be of use during emergency and nonemergency situations. It is also essential that a US air ambulance or worldwide air ambulance service complies with the State as well as local laws.

Air Ambulance Equipment Requirements According to Medicare

The medical flight must be equipped with linens, stretcher, medical supplies for an emergency, oxygen supplies and equipment, and other vital emergency lifesavers or life-sustenance equipment. It must also contain support equipment such as neck and back boards, inflatable arm and leg splints. The air ambulance must be complete with necessary signage that signifies it is a medical flight. Telecommunication equipment must be present in accordance with the State or local law. In other words, there should be one wireless telephone or two-way voice radio at the minimum.

Adequate Staffing of Air Ambulance According to Medicare

If a basic life support air ambulance is chosen, it must have two people at the minimum with at least one of them being a certified EMT or emergency medical technician. The certification must have been granted by the state or local authority. The person must have legal authorization to operate lifesaving equipment onboard the medical flight. Any advanced life support air ambulance too must be staffed with two people with at least one being an EMT paramedic or EMT intermediate.

Statement of Compliance to be Furnished by Air Ambulance Service Provider

A statement that signifies compliance to norms laid down by Medicare is necessary for reimbursements. Medicare might ask the air ambulance service provider to furnish these at its discretion, although the information might not be asked for with every flight. The documentary evidence must contain letters from State or local authorities such as certificates, permits and licenses to name a few. Although checking for compliance is not a beneficiary’s responsibility, keeping oneself informed always helps.

Air Ambulance Transport, Medical Insurance and Travel Overseas

We have already discussed previously that air ambulance transport can cost up to $100,000 when it involves crossing international borders. Now, add this amount to the medical expenses you incur overseas and your trip can turn out to be a physical and financial nightmare. Your Medicare and Medicaid will not cover you in a foreign country unless you have purchased supplemental coverage. However, they have no provisions to cover for air ambulance transport overseas whatsoever. Most health insurance policies like Aetna and Blue Cross too won’t cover you for air ambulance transport in situations like these, although they do cover emergency care. You might have to first pay out of pocket and ask for reimbursement later.

Look for Options that Cover Air Ambulance Transport Overseas

As a matter of caution, it therefore becomes necessary that people travelling abroad look at options that actually cover air ambulance transport back home. Let’s explore some of these:

  • Travel Guard by AIG is one such option. This includes medical evacuation, which means you have medical insurance along with air ambulance transport charges covered through the policy.
  • Med Jet Assist is another option. The only requirement here is that you are 150 miles away from your home. The membership allows the patient to fly back to the hospital of choice once medically stable. Med Jet Assist charters air ambulance transport for this purpose.
  • Air Med is also an option which gives you the same benefits as Med Jet Assist does. The only difference here is that Air Med owns its own fleet for air ambulance transport.
  • Air Ambulance Card is another company that offers similar services as Med Jet Assist and Air Med.

Never Travel Overseas without Air Ambulance Transport Coverage

It is impossible to compensate for the unfortunate hardships you suffer overseas sometimes. However, having adequate air ambulance transport coverage ensures that you get the best medical care in your home country. Often, the exotic locations that you travel have unhygienic and inadequately staffed hospitals. You do not want to be compelled to seek treatment in such conditions. Good air ambulance transport coverage insulates you from such situations. Plus the amount you pay for such coverage is negligible considering the cost of overseas air ambulance transport.

Air Ambulance Transport – A Dangerous Profession

Wanting to help the needy by being part of air ambulance transport is no doubt a noble intent. However, the profession is fraught with several dangers and is counted among the most dangerous professions in the world. People who aspire to join air ambulance transport sector must give due consideration to certain aspects of the sector. Apart from the fact that air ambulance transport services cater to people in war torn areas, natural disasters and global epidemics such as the recent Ebola threat, there are other factors too that must be considered. Here, we highlight a few of those.

Air Ambulance Transport Crews are More at Risk than Patients

One simple reason is the fact that more than one crew member accompanies a patient usually. The second reason could be that the crew usually has to make more flights, one to pick the patient, one to drop and another trip to return to the air base. All this while the crew, with the inadequate safety standards, is exposed to more danger.

There is also a sense of urgency that surrounds most air ambulance transport trips. For instance, if a patient has had a heart attack, the first priority is always to transport the patient to the nearest medical facility within the first hour.

Some air ambulance transport industry experts have also raised concerns about the competition that exists between air ambulance transport companies to make the maximum number of flights. Such a “race” naturally puts the air ambulance transport safety in the backseat.

Stricter Rules for Air Ambulance Transport in the US are on the Way

The need of the hour, therefore, is stricter regulations. American air ambulance transport sector can take a leaf out of the Canada which has stricter regulations. For instance, it is mandated that at least two pilots must be present in every air ambulance trip. That said, the FAA has now proposed new safety rules, which will be implemented by 2015. The regulations have come into place after many postponements and delays. On the positive side, however, we hope that the new rules make air ambulance transport safer for the crews.

Advanced cardiac life support (ACLS)

Advanced cardiac life support (ACLS) refers to a series of medical treatment actions performed for the urgent treatment of cardiac arrest, stroke and other life threatening medical emergencies, as well as the knowledge and training needed to carry out the actions and properly handle the situation.  ACLS guidelines are set into several groups of ‘algorithms’ – a set of instructions that are followed to standardize treatment, and increase its effectiveness. These algorithms usually come in the form of a flowchart, incorporating ‘yes/no’ type decisions, making the algorithm easier to memorize.

Advanced Cardiovascular Life Support (ACLS) Details

Advanced cardiac life support (ACLS) refers to a series of medical treatment actions performed for the urgent treatment of cardiac arrest, stroke and other life threatening medical emergencies, as well as the knowledge and training needed to carry out the actions and properly handle the situation. When a sudden cardiac arrest occurs, immediate CPR is a vital link in the chain of survival. Another important link is early defibrillation, which has improved greatly with the widespread availability of AEDs.

Algorithms

The current ACLS guidelines are set into several groups of ‘algorithms’ – a set of instructions that are followed to standardize treatment, and increase its effectiveness. These algorithms usually come in the form of a flowchart, incorporating ‘yes/no’ type decisions, making the algorithm easier to memorize.

Training

The major source for ACLS courses and textbooks in the United States is the American Heart Association and in Europe is the European Resuscitation Council (ERC). Most institutions expect their staff to recertify at least every two years. Many sites offer training in simulation labs with simulated code situations with a dummy. Other hospitals accept software-based courses for recertification. An ACLS Provider Manual reflecting the new Guidelines is now available.

Required skills

Only qualified health care providers can provide ACLS, as it requires the ability to manage the patient’s airway, initiate IV access, read and interpret electrocardiograms, and understand emergency pharmacology. Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. Qualified personel include: physicians (DOs and MDs), pharmacists (PharmDs), dentists (DDS and DMDs), midlevel practitioners (PAs and NPs), nurses (RNs), and paramedics. Other emergency responders may also be trained. Some health professionals, or even lay rescuers, may be trained in basic life support(BLS), especially cardiopulmonary resuscitation or CPR.

Electrocardiogram interpretation

It often starts with analyzing patient’s heart rhythms with a manual defibrillator. In contrast to an AED in BLS, where the machine decides when and how to shock a patient, the ACLS team leader makes those decisions based on rhythms on the monitor and patient’s vital signs. The next steps in ACLS are insertion of intravenous (IV) lines and placement of various airway devices. Commonly used ACLS drugs, such as epinephrine and amiodarone, are then administered. The ACLS personnel quickly search for possible causes of cardiac arrest (i.e. the H’s and T’s, heart attack ). Based on their diagnosis, more specific treatments are given. These treatments may be medical such as IV injection of an antidote for drug overdose, or surgical such as insertion of a chest tube for those with tensionpneumothoraces or hemothoraces.

Guidelines

2010 ACLS Guidelines

In 2010 the American Heart Association and the International Liaison Committee on Resuscitation updated the ACLS guidelines. New ACLS guidelines focus on BLS as the core component of ACLS. Changes include the exclusion of Atropine administration for pulseless electrical activity (PEA) and asystole and a new change in arrangement of CPR steps to be CAB rather than ABC. Additionally, the changes include end tidal CO2 monitoring as a measure of CPR effectiveness, and as a measure of ROSC.

2005 ACLS Guidelines

As of 2005, stroke is also included in the ACLS course with emphasis on the stroke chain of survival.The 2005 guidelines acknowledged that high quality chest compressions and early defibrillation are the key to positive outcomes while other “typical ACLS therapies … “have not been shown to increase rate of survival to hospital discharge”. In 2004 a study found that the basic interventions of CPR and early defibrillation and not the advanced support improved survival from cardiac arrest.

 

Air Ambulance – Children

Children are very resilient patients who often do not show signs of a severe illness or injury until they are close to death and then suddenly deteriorate. When this occurs, they require access to neonatal and pediatric intensive care units, which are becoming increasingly limited. Therefore, the care of these neonates, premature infants, and young children is another primary use of Air Ambulance and Medical Flights, with the speed and higher level of care provided en route by an air medical team.

Air Ambulance – Pregnancy

When a pregnant woman experiences complications, they can be life-threatening for both mother and child, and often require the specialized care found in larger hospitals. Timely Air Ambulance transfer to such facilities while the patient(s) receives care from obstetrical/ neonatal specialists has been shown to be safe, cost-effective and beneficial. Transfer via critical care ground ambulance is also successfully employed in these kinds of cases. However, when time is critical and a specialty team from the receiving hospital is sent to bring the patient(s) to the specialty center, air ambulance transport minimizes the out of hospital time for both the patient and the specialty care givers in a way that cannot be accomplished via ground.