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.
It is hard to believe that the future will see more efficient emergency transportation than air ambulances. However, it is true and that future is not very far. The advent of smart vehicles, autonomous driving technology, drones, electric power and the like are transforming emergency transportation today. In the age of patient centricity, the technology that suits the patients’ requirements will rule the industry. While vehicles capable of landing vertically will make a huge difference in treacherous plains, swiftly moving vehicles will be in demand when time is vital. Here, we take a brief look at the different technologies that are making waves today.
Flying Cars and Air Ambulances
Flying cars have been testing human imagination since the 1980s. Their biggest advantage is their ability to take off and land vertically, as well as the fact that they are highly compact. Now, with technology enabling efficient ground support, it will come as no surprise if we see flying cars being used as air ambulances. The other major advantage from the air ambulance service providers’ point of view is the ability to store or park these vehicles without much expense. The current system where they are expected to hire spaces in large hangars can be done away with if flying cars become a reality and can in turn bring down the cost of availing the service too.
Drones and Autonomous Vehicles
A lot of innovation and research has gone into autonomous vehicles and drones. In fact, a combination of these technologies can be quite exciting. Imagine a scenario where an air ambulance company dispatches an autonomous drone capable of handling heavy loads while controlling it remotely. There would not be a need for pilot. This will also make more space for the patient in the compact vehicle, where he or she gets all the life support required.
The technology that guides air ambulances will further improve as artificial intelligence, internet of things, big data and the like progress.
Medical flights are nothing to look forward to but preparing for them does take the stress off somewhat. Let’s look at different aspects of medical air transport and see how you can be prepared for them.
Here are a few details that the flight coordinator will ask you. Keep them handy when you go on a call with one.
- The name of the patient
- Date of birth of the patient
- Weight as well as height of the patient
- The mobility status of the patient: can he walk, sit, stand, etc.
- Contact information of the patient and/or the caregivers
- Specify the need for special equipments such as oxygen, intravenous lines, etc.
- Health insurance details
If the patient is being transferred from one treating facility to another, you must have the following records handy:
- Copy of the health insurance documents
- Copy of the discharge summary as well as the most recent copy of history and physical exam
Before Boarding Medical Flights
There are specifications that medical flights lay down when it comes to luggage that the person accompanying the patient can carry. Know about that well in advance. Also, there are usually limitations on the number of people who can accompany the patient. Usually, it’s just one person. The person accompanying must bring along an identification document.
If You Make Receiving Arrangements
There are instances where people make bookings well in advance so that the patient is admitted to the hospital that his or her family desires. If that’s the case with you too, inform the care coordinator in advance so that a land ambulance can be arranged to take the patient to the treating facility. If the receiving facility has a helipad, then the coordinator will keep the hospital informed of your arrival so that appropriate arrangements can be made.
Traumatic brain injuries can be fatal and demand urgent medical attention that airambulance services can provide. According to a statistic by the Centers for Disease Control and Prevention, traumatic brain injuries are among the leading causes of disability and even death in the United States of America. To put a number to the extent of its dangerousness, traumatic brain injuries account for about 30% of all deaths associated with injuries. The leading causes of brain injuries in the country are assaults, motor vehicle accidents, sports related mishaps, and falls. While the risk of falls is considered high among senior citizens, sports are a major cause for traumatic brain injuries among the younger population.
Ambulance Sometimes Becomes a Necessity in Traumatic Brain Injuries
The survival rate of a patient increases drastically if he or she receives treatment right on time. This is where airambulance services come into play. If the injury occurs in remote or rural areas where access to adequate neurological care is next to impossible, the only recourse that remains is transportation by airambulance. Among the advantages of using airambulance services apart from the speed is the comfort and facilities that they offer. They are usually better equipped. Also, the chances of secondary trauma owing to transport are almost zero when the airambulance is used for transport.
The Immediate Symptoms of a Traumatic Brain Injury
It must be noted that the symptoms related to traumatic brain injury vary based on the severity of the injury. Patients are usually seen experiencing mild-to-severe changes in personality or behaviour, loss of sensation in any or several parts of the body, muddled or impaired thought process, loss of memory, impairment in vision, slurring of speech, inability to move one or more parts of the body. Airambulance services usually employ specific protocols when traumatic brain injuries are involved and utmost care is taken to keep the patient safe so that the chances of long-term consequences are minimum to none.
Of course, it all begins with the aircraft model that a medical flight company purchases. Each aircraft is different in some way or the other. However, once the purchase is made, there are certain aspects that one must consider to ensure that the medical flight is fit and convenient enough to provide the healthcare that is expected of it. Here, we discuss a few of those in some detail.
The Floor of the Medical Flight
The floor is a very critical part of the medical flight. It must be such that the in-flight as well as maintenance crew must be able to clean it efficiently and quickly. The emergencies that come a medical flight’s way can involve a lot of blood and other elements, which need to be cleaned out as quickly as possible to maintain hygiene. This might necessitate floor drains and the design must be such that modifications like these can be easily made. Also, the floor can see a lot of heavy equipment which is often moved with little care for the floor itself, so the floor must be sturdy enough to take such abuse.
Important Considerations that Must be Kept in Mind
Today, it is necessary that an aircraft has modern connection facilities such as USBs. Customization is another factor. Depending on the situation, the crew must be able to quickly put in cabins, add/remove seats and/or stretchers. Proper mounts for medical devices must already be in place. While all such facilities bring in a high level of convenience, safety remains the primary concern. For this reason, all the modifications must be certified by a competent agency.
Care must be taken to make use of the space available to the maximum. For instance, the stretcher must be able to double up as a bed that can be immobilized on the flight. Plus, the space beneath the stretcher could be used for storage by building custom cabinets. It is obvious that a one-size-fits-all approach generally does not work; however, a creative approach to the medical flight interiors can go a long way to make it comfortable and efficient.
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.
Medical air transport professionals are usually the first to respond to emergency calls and trauma scenes are sometimes very stressful to handle with death and serious injuries being a part of it. Medical air transport professionals do not even get time to let the situation sink in as they are expected to act immediately. This can cause quite a lot of mental trauma to them. Added to this is the physical stress of the entire situation where they have to move the patient, equipment, etc., so that lives can be saved.
Common Mental Ailments among Medical Air Transport Personnel
Research shows that depression, PTSD or post-traumatic stress disorder, fatigue and anxiety are highly prevalent among medical air transport professionals. The tragedy of the matter is that they do not often get time to introspect into their mental wellbeing because of the situations that they often find themselves in where they are expected to be highly reactive to the surroundings. By the time they realize their mental state, they are already deep into these psychological ailments. While it is a shared responsibility of the employers and the personnel, here are some tips to stay mentally healthy.
Tips for Mental Health
- Increasing mindfulness through meditation: Meditation allows people to take a step back and introspect. All the deeply buried feelings come to surface and one becomes in-tuned with his or her own mental state. The ability to detach oneself from sufferings around is greatly increased.
- Confiding in others: Every person has friends or colleagues that they can talk to. Getting certain things out of our system can help. It’s a sort of an outlet. Medical air transport professionals can also make use of in-house psychologists to open up. Even keeping a journal can help.
- Exercising to reduce stress: Endorphins that result from exercise can get rid of stress to a huge extent. Air ambulance professionals must make physical activity of their choice a part of their daily routine.
Finally, it is vital that people speak out when they are under stress. There is nothing wrong in seeking help when it is warranted.
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.