Imagine heading a business where customers only pay you 30% of the time in full and the remaining 70% only pay you 50% of the cost. How would your business survive? This is precisely the situation of most air ambulance companies in the United States of America say industry experts. What adds insult to the injury is the fact that there is a outcry about the charges both in national media as well as people, not to mention the politicians who are trying to pin all the blame on air ambulance companies. Most players in the industry say that air ambulance business is getting harder by the day to run.
Air Ambulance Companies Asked to Do More
Rural hospitals in the US are closing down at a rapid rate. More and more rural patients are veering towards the services extended by air ambulance companies. However, the fact remains that air ambulance services are expensive and the costs are not being reimbursed by health insurance providers citing several reasons. While the most common is the ‘lack of medical necessity’ others simply have a small ceiling of reimbursements that have not been revised for a very long time.
Most of the Air Ambulance Costs are Fixed
Costs of running a medical base is, on an average, about USD 3 million a year. This amount accounts for about 85% of the costs and are fixed. These include maintenance of the aircraft, hangar, support staff, crew and the like. Then there are write-downs that are either forced upon the air ambulance companies or the ones that they undertake themselves on humanitarian grounds. All this adds up to a huge amount. Plus, there are always the running costs such as fuel which is also quite expensive. Industry experts feel that the demand for the services provided by air ambulance companies is going to increase considering that the population is aging, and that something needs to be done on a war footing to make the reimbursements commiserate with the services provided.
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 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.
There are several terms used to describe a situation where a medial flight does not arrive even after a call. The reasons behind this could be several but it is important to categorize these using appropriate terminologies so that an organization that owns the medical flights can optimize and also gauge its effectiveness. It makes gathering of meaningful data easy. Let’s explore these terminologies in some detail.
Cancelled Medical Flight Calls
The category ‘cancelled’ should only be used to describe those situations where the medical flight has taken off, but it is asked to return when it is en route to the patient’s location. The reason behind this could be demise of the subject that warranted the air ambulance service in the first place or a change in situation where it is felt that the medical condition is not serious enough to warrant a medical flight.
Stand Down of a Medical Flight
When the risk of flying to a particular location is too high, the mission to serve the patient is usually abandoned. All such instances must be categorized under ‘stand downs’. This directly affects the dispatch rate but it is a call that must be taken keeping the safety of the crew in mind.
The decision to abort a medical flight mission is usually only taken when the weather condition is too harsh to fly. Missions can also be aborted owing to mechanical problems or inability to fly during bad light.
Once all the missed flights are segregated in the above categories, it becomes easy for the medical flight service provider to gauge what is causing the changes in the dispatch rates. Any areas of improvement such as night vision must be dealt with so that superior service and better dispatch rate can be achieved. The categorization also helps medical flight organizations to set targets and better organize themselves.
As we have time and again discussed, the decision to avail a medical flight service, most often, is in the hands of the treating physician and the patient has little say in it. However, it is always good to have the knowledge of what constitutes a medical necessity for availing an air ambulance service.
Criticality of Time and Treatment Facility
In a situation where the injury or health condition is serious enough that immediate medical attention is warranted and an air ambulance can cut down the travel time greatly, such a service becomes a necessity. It also becomes a necessity when the medical facility in which the patient is receiving treatment is not equipped enough to handle the patient’s condition. The patient may be in need of immediate advanced medical care.
Accessibility to Ground Ambulance and Availability of Medical Flight Service
Certain areas, especially rural, might not have the land infrastructure to transport the patient. In such cases, if a medical flight service becomes available right away, it can be a real life saver. For a medical helicopter, all it takes is a helipad, which most hospitals have today.
Does the Local Ground Transport Leave the Local Area with Inadequate Coverage?
This is an important question that needs to be answered. Rural towns, often have just one or two air ambulances for the entire community. Shifting a patient to a medical facility that is quite a distance from the home base can leave the local community without adequate emergency medical access. A medical flight may be opted in a situation like this.
Medical Facility Available in the Transport Vehicle
Ground ambulance may lack in certain critical care equipment that are available in a medical flight service. In a situation like that, even if time is not a factor, the patient might still be transported via a medical flight service.
Air ambulance service, as a business, is not short of challenges, budget being the first concern but not the least of it. A good business plan that lays out the path to profitability can easily attract investors. However, there are other challenges that are seldom looked into by most entrepreneurs. Here, we discuss some of those road blocks in some detail.
Understanding the Legislations Across the World
The air ambulance industry in the US, as most experts opine, is pretty saturated. It is, therefore, recommended that entrepreneurs target the global market. This necessitates looking into legislations that govern the land. While the norms in most developed, capitalistic countries are similar, they can vary a lot when it comes to developing countries and socialistic policies too can pose some government roadblocks. It is wise to employ an array of consultants to overcome this hurdle.
Provision of Round the Clock Air Ambulance Services
Failure to respond to emergencies can leave your organization with negative public perception problem. To ensure that air ambulance services are always available throughout the year, it is necessary to make arrangements to be available throughout all weather conditions. Also, medical staff needs to be on standby at all times, even though this means additional overheads. Most air ambulance companies overcome this problem by transferring this overhead costs to the end consumer. However, the wisest thing to do is introduce memberships for nominal fees. Efforts must be made to remain ‘in coverage’ of insurance networks so that reimbursements are seamless.
Acquiring Air Ambulance Fleet and Keeping the Staff Well Trained
Air ambulance industry demands seasoned, qualified professionals and it’s hard to find people who fit this criterion. Plus, there is the issue of ongoing training to the staff. Accredited training organizations must be looped in to meet this challenge. Lack of ongoing training can impact the quality of services immensely.
The Commission on Accreditation of Medical Transport Systems and the European Aero-Medical Institute are perhaps the two most well-known organizations that offer accreditation to air ambulance service providers. While the former is primarily for the United States, the latter caters to the European continent. There are several air ambulance companies that certify their quality services through these accreditations. Then, there are those companies that are equally quality oriented but are not accredited. These medical flight companies are usually smaller in size and cannot afford accreditations. This raises the question: are accreditations really needed or is it just another additional cost?
The Benefits of Air Ambulance Service Accreditations are Several
For one, insurance companies are more willing to take an air ambulance service provider in their network coverage when they are accredited by a well known organization. It is an assurance of high quality standards and safety. Many private players who tie up with air ambulance companies too prefer such certifications before tying up for their services. For medical flight service providers, therefore, it makes sense to spend money on such accreditations. Even hospitals and customers veer towards those organizations that have recognized accreditations.
The Constantly Evolving World of Air Ambulance Accreditations
The rules that govern the air ambulance industry constantly evolve. Bodies like Federal Aviation Administration of the United States up the standards that govern air ambulance companies constantly. When this happens, the organizations that offer accreditation automatically are forced to change their standards. For air ambulance service providers, this means upgrading their certifications on a regular basis to stay current. Moreover, these accreditations must follow not just the norms of their own countries since air ambulance services are increasingly going global. An accreditation organization that only caters to a single country risks being ignored as there is a chance of the service providers preferring other more global options.
Being a physician in fixed-wing medical flights is no small task. Being responsible for a patient in an intensive care unit setting, hundreds of feet above the ground while he battles for life can be quite daunting. What compound the gravity of the situation are the limited resources at the disposal of physicians manning the medical flights. It’s only the world- class training and a cool, professional head on the shoulders that comes to aid in situations like this, day in and day out. Here, we describe some of the training requirements that are typically needed.
Initial Training for Medical Flights
Well, the training starts even before one applies for the job. The training is a little different from the one that you receive in hospitals. You need to be adept in working with limited resources. Also, it is important to understand that problems that one can face up in high altitudes. Gas pockets within the body and limited oxygen are just some of those. Training is optional in some regions but in others, they are absolutely mandatory. The documentation of such training might needed to be vetted by organizations like National Accreditation Alliance for Medical Transport Applications. The training, however, can be obtained through organizations like European Aero-Medical Institute or Commission on Accreditation of Medical Transport Systems.
Keeping the Skills Current for Medical Flights is Vital
Some skills are more important than others, like the ability to intubate a patient quickly. Yearly ALS refresher courses are expected to be in place by most medical flight companies. Since, hospitals often see critical patients, experience handling them in emergency settings is considered an added advantage by most air ambulance companies.
Ongoing Training for Full-Time Professionals on Medical Flights
Most of the reputed air ambulance companies offer their medical staff ongoing training. While some of this training is conducted in-house, others may be outsourced to external agencies that are accredited. In all, these efforts and checks are put in place for the safety of both the medical flight professionals and the patients under their care.
When faced with an emergency situation concerning the life of a loved one, cost is the last thing that you want to worry about. However, it is always wise to have an idea of the costs involved in emergency situations and medical flight services are one of those. With the cost having doubled over the past decade, you must know what to expect if you’re opting for a medical flight. While most of the costs will be covered by your health insurance, you would still want to keep the costs low as you might be forced to pay the unapproved balance amount as it so often is seen happening.
The Cost of Ground Transportation
One cannot completely discount the fact that a ground ambulance may be required to transport the patient. It becomes an absolute necessity when it’s a fixed-wing medical flight, which can only take off from an airport. Even choppers can, at times, not reach the patients owing to the terrain and ground ambulance services may be needed.
The Destination of the Medical Flight
This is an obvious factor. The longer the medical flight, greater the cost. The nearest appropriate treating facility might be quite far and sometimes across borders – all this ultimately translates into higher cost.
Medical Flight Landing Fees
The landing fees depend on the duration that a medical flight uses the landing facility. This becomes a part of the final bill.
Type of Medical Flight and Number of Medical Staff
Long flights typically demand fixed-wing air ambulances. These can be more expensive than choppers. They are generally better equipped and considered more comfortable. The number of medical staff is also a criterion. Certain medical conditions demand that professionals in more than one field of medicine be present in the air ambulance and this can push the costs up.
While there may be other cost factors too, the ones discussed above are the major ones.