Imagine a situation where a patient is in a life-threatening situation and a medical flight is an absolute necessity. The treating physician recommends an air ambulance. However, when a call is placed for dispatch, the service provider refuses to comply. The reason behind this is bad weather conditions. The hospital then calls several other service providers until they find one that is willing to take the risk. This is called medical flight shopping. While this might seem to be a logical recourse for the patient, it is not always desirable. The risk taken by the patient and the crew is huge in such circumstances. Why do air ambulance service providers agree to such a call?
The Pressures on the Medical Flight Industry
There are over a thousand medical flight service providers in the United States. This means they have to divide the existing customer base within themselves. Plus, most of these businesses are privately funded so profits matter. Rejecting patients for whatever reason does not serve the profit motive of these investors. Hence, the crew is compelled to take the call of answering to the need. However, this eventually places a huge financial burden on the patient. Let’s understand how.
The Out of Network Issue
In a situation where the need for medical flight service is huge and time is short, the patient does not really have the option of choosing a service provider. Most often, the service that he or she ends up with is one that is not covered by the insurance provider. While the insurance might cover a base rate, medical flight companies do not always comply with such rates. As a result, the patient is later compelled to cough up a steep price that the medical flight company charges in the form of balance bills. Medical flight shopping thus is a high-risk and expensive affair – a practice that must be relooked.
Connected vehicles are making big waves these days, especially cars. Medical flight services can be enhanced by leveraging this technology. Wondering how? Read on. Connected vehicles are based on the fact that data can be transmitted from one vehicle to a dashboard where the relayed electrical impulses can be translated into a language that is intelligible to human beings. The purpose is to take appropriate action based on the insights received. This communication is enabled through a combination of satellite connectivity, mobile phone towers, SIM cards, and sensors. Let’s take a look at the ecosystem of these tiny devices before we get into how they facilitate quick medical flight response.
Understanding Connected Devices
The sensor fitted in the vehicle, for instance a car, takes into account factors such as the geographic location of the vehicle, the speed, the extent of impact (in case of accidents), occupant health such as vital signs (through connected wearable devices),as well as the vibration, temperature, and sound of the vehicle. It constantly monitors and analyses these parameters. If one of them is off beyond a certain limit that is considered unsafe, it sets off an alert by leveraging mobile connectivity and satellites to a predefined location – for instance the nearest emergency response team.
How Connected Vehicles Help Better Medical Flight Response
For one, the call for help is immediate. Second, the call for help is accompanied by a wealth of data pertaining to the distance and exact location of the accident along with the occupants’ health-related data. This can be of immense help to the medical flight that is responding to the emergency. It can get onboard appropriate healthcare equipment as well as experts. Since the location is precise, reaching it becomes that much easier. It also helps them prepare the receiving facility well in advance. The result is invariably a better chance of survival.
A medical flight paramedic is a part of the support team that acquires immense importance every time there is a medical emergency. They work in conjunction with physicians and nurses. Medical flight paramedics almost invariably fly to the scene of medical team in the air ambulance. It is a frenzy of activities once they reach the spot, where they are expected to diagnose the patient, evaluate the situation and deliver the best life-saving care possible so that the patient can be transported safely to the appropriate treating facility. The job demands keeping a cool head under pressure.
The Career Prospects of a Medical Flight Paramedic
It is believed that in 2011, there were about 2,000 flight paramedics in the United States. However, the numbers have steadily grown since then. The growth is expected to be at a rate of about 23% until 2022. According to statistics that date back to 2012, the median salary of a flight paramedic was slightly over $31,000 but it is safe to assume that the amount has gone up drastically owing to increased demand. Industry experts believe that the demand will go up further as rural American hospitals are closing down rapidly, in turn fuelling the need for air ambulances.
Requirements to become a Flight Paramedic
The candidate must be at least 18 years of age and be certified as an EMT or emergency medical technician. The course must be approved by NREMT. The person should have worked as a paramedic for at least three years already and have CPR as well as paddle training. Other factors such as physical fitness are also important.
Here is a list of certifications needed:
- Prehospital trauma life support
- Advanced pediatric life support
- Advanced cardiac life support
- Basic life support
- NREMT, ATLS-Audit, TNACT, and CCEMTP
Once these certifications are acquired, the candidate must pass FP-C exam to ultimately start career as a medical flight paramedic.
The Right Questions to Ask a Medical Flight Company
Medical flights become a necessity when ground ambulances are not a choice. However, when the need for transport is not urgent, you have the time to make a sound choice, but first, you must know what questions you must pose to the medical flight company. Here, we discuss a few pertinent ones.
Does the Medical Flight Service Come Under My Insurance Network?
Health is important but cost is a factor too. Medical flight services can be quite expensive. When given a choice, you must exercise it to know what you are getting into. Air ambulance transport bills can run into the tens of thousands and in the hundreds of thousands, if the destination is across borders.
What Mode of Medical Flight is Right for Me?
Fixed-wing air ambulances are slightly more expensive than helicopters. However, they are quick and much more comfortable. In fact, preference must be given to fixed-wing flights if the journey is long. One major limitation, however, is its ability to land. Unlike helicopters, they need extended landing grounds.
Is the Air Ambulance Equipped Enough?
Today, one can hire air ambulances that suit the prevailing medical condition of a patient. For instance, you can hire one that is a flying neonatal care unit, if the patient is a newborn. Mission critical equipment like ECG monitors and the like must be available if the situation demands it.
Will the Organization Coordinate Care Beyond the Flight?
Most medical flight companies will offer you services that go beyond simply taking you from one place to another. They coordinate care with the receiving facility and keep in touch with ground ambulances if their services are required. If it is a cross-border transfer, the service provider may help you with the necessary formalities too.
These are some of the vital questions that one must ask before opting for a medical flight service to avoid any nasty surprises later.
Well this might not come to you as a surprise because you might have witnessed this yourself. According to one survey conducted by Kaiser Family Foundation, about 40% of US citizens have revealed that their families have received a medical bill despite being covered by medical insurance. This is a growing problem for the country as insurance companies are seen restricting the number of providers in their networks. Of course, out of network providers are not covered by insurance companies. In this context, the question arises, is it the same logic behind huge medical flight bills that people across the country are witnessing?
Medical Flight Bills and Insurance Network
A majority of industry experts believe medical flight service providers willingly stay out of insurance networks. The reason is simple, they lose the freedom to charge what they feel is fair for their services. It is also felt that there is a huge disparity between what the medical flight industry believes is a fair payout and what the insurance industry pays. The middle ground, it seems, is something that has not been achieved so far. The issue has not gone unnoticed by the lawmakers. However, the opinion is divided as to who is responsible for the huge bills.
Efforts by Lawmakers to Bring Down the Bills
Several attempts have been made to limit the amount that can be charged for medical flight services. From trying to ban balance billing to compelling air ambulance companies to come under insurance networks, several innovative efforts have failed. The reason behind this is the Airline Deregulation Act of 1978. Designed to create a competitive environment to keep the price of this essential service down, it precludes the state governments from intervening in the matters of air ambulances. Only the Federal Government is authorized to make changes.
Bystanders are often left wondering how to handle emergency situations. If the medical necessity is grave enough to warrant a medical flight, live streaming the emergency situation to the first responders through video streaming can be quite helpful. With the connectivity and mobile enablement that the world enjoys today, making this possible is not a tough ask. All it would take is an app that covers privacy, consent and similar concerns. The chances of the injured or ill getting immediate help becomes easy. Bystanders can get instructions from qualified first responders.
Addressing the Privacy Concern
The app will certainly help the patients immensely; however, there can be privacy concerns. The solution – treatment, if needed, can be delivered after an expressed consent from the patient. Moreover, the video need not be recorded or stored on either ends, both the patient and first responders. In fact, the kind of application is already being used in United Kingdom. A dedicated solution like this to emergency response centers, can do a lot of good. Since every medical flight covers a huge amount of distance, people, especially in rural America, can benefit significantly.
The Need for Medical Flight Can be Gauged
In situations where there is no qualified medical professional to make a decision whether the patient needs emergency medical flight services, the mobile app can be of immense help. The ‘medical necessity’, which plays a huge part in insurance approvals, can be determined quickly and effectively so that the patient is free of such worries from the word go and where applicable, an informed decision can be made.
Integration of such an app widely is important. If each player in the medical flight industry comes up with a unique platform to execute this, it would be a disaster. What the industry needs is a common platform so that execution becomes easy.
Imagine this: the medical flight has emergency personnel seated in it and is en route to pick up a patient in a remote area but there’s one crucial member of the crew missing. Guess who? The pilot! Yes, that’s right! The medical flight technology is slowly moving toward autonomous flights that are sans pilots. If this sounds like science fiction to you, here’s a surprise. SkyRyse, which is a Silicon Valley start up, is already testing autonomous helicopters in emergency settings. It is known to have carried police and emergency personnel safely in response to mock emergency calls and the testing will continue.
How Safe is the Autonomous Medical Flight Technology?
Experts feel that it is quite safe. It is believed that the flights use the same technology that is used in driverless cars. A combination of software and hardware that is continually monitored from the control room and a medical flight that is controlled by itself – that about sums up what this technology is all about. Although the technology is still in a nascent stage, it will make huge strides in the days to come. A lot of this technology’s development will depend on machine learning and artificial intelligence which will allow it to learn the nuances of flying without any human intervention.
The Factors that will Make this Technology a Success
Ask yourself this question, “Am I ready to take a medical flight that does not have a pilot?” Trust of the customers in the new technology is going to be a decisive factor. Then there is the cost. It is a tussle between the cost of acquiring such a technology and the return on investment that it ultimately brings. Will this new technology demand high maintenance cost? Or will it reduce it? Regulations are another factor. Innovations that have the potential to give rise to safety risks typically take longer to get government approvals. For now, it’s a wait and watch for all of us.
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.
Let’s understand the scenario with a hypothetical situation – a patient has suffered a serious injury and is in Carthage, Missouri. It is felt that the most appropriate facility to treat the patient is in Joplin, which is just about 12 miles from where he is. A medical flight is summoned, in spite of the ground ambulance being ready to take the patient. The medical flight takes about an hour to reach the patient and another 15 minutes to reach the treating facility. A week elapses, just when the patient is thanking his stars that he was lucky to receive the treatment on time, he is slapped with a balance bill of $25,000. The insurance company has covered $20,000 of the total $45,000 bill. The once happy patient is now contemplating mortgaging his house to pay off the balance bill.
The Argument Against Medical Flight Company
The insurance company argues that the ground ambulance was readily available and the destination was just 12 miles away, which would have taken the ground ambulance about half an hour to reach. Yet, a medical flight was called in, even though it took an hour for it to simply reach the patient. The insurance company feels there was no need for the medical flight service in the first place and refuses to cover the bill in full. In the outset, the argument seems right but only until what the medical flight company has to say.
Looking at the Situation from the Medical Flight Company’s Angle
Medical flight companies do not and cannot choose to take a call whether they want to fly a patient. They are summoned by the hospital and the medical necessity is decided by the treating physician. Come to think of it, the treating physicians usually have a sound logic behind suggesting an air ambulance service. The ground ambulance might not be best suited, owing to the patient’s condition.
What needs to be done in contradictions like these is following a middle ground and for this, there needs to be a mechanism in place where things are sorted out between medical flight and air ambulance companies. Until that happens, the patient will continue to suffer.