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.
The life of medical flight professionals can be quite adrenaline pumped most of the time but that does not preclude them from the responsibilities that come with being a part of the air ambulance industry. The training, the safety measures and the need to be on the call all the time are just some of the tasks that they are expected to undertake. Of course, the gratitude that they receive for saving lives is an additional bonus that perhaps every medical flight professional enjoys. Most people who become a part of the air ambulance industry very well know that they are stepping into a high stress job.
The Routine Tasks of Medical Flight Professionals
While the pilot is expected to run routine checks to keep the chopper health up, the medical flight crew members are required to ensure that all inventory and medical equipment are in place, the batteries are all charged up and basically ensure that all equipments are working fine so that they can effectively respond to emergencies. The station duties can range from keeping a tab on the blood fridge and logging fridge values to cleaning and taking out the trash. Each member assumes a responsibility when they are docked in the hangar.
Responding to Emergencies
While the medical flight professionals usually conduct several station duties, they subconsciously are always anticipating an emergency call. The moment it comes in, they are expected to leave everything and take up the duties that enable them to face the emergency effectively. They immediately do all that is needed to know about the patient health condition and equip the medical flight with all the necessities. The medical staff are alerted in the nearest appropriate hospital and logistics are quickly and efficiently taken care of. It should be noted that, in view of the fact that the entire routine is quite stressful, the crew is always allowed enough rest hours every day and are encouraged to get enough relaxation between shifts.
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.
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.
The advancement in medical flight performance has a lot to do with the development in oxygen equipment in recent times. Typically, medical flights make use of portable oxygen equipment at altitudes less than 10 thousand feet above the sea level and fixed oxygen equipment if attitudes above 10 thousand feet are achieved by the air ambulance on a regular basis. Typically, the oxygen equipment consists of storage system, tubing, gauges, and mask. Traditionally, oxygen has been carried in gaseous form; however, the new advancements in technology have made way to solid stage oxygen which allows for carrying of greater quantities of oxygen.
Equipment Check Before the Medical Flight Takes Off
It must be ensured that all occupants of the medical flight are well aware of how to don and doff oxygen masks and fit the head harness properly. They should also be knowledgeable about checking the pressure gauges and indicators. Of course, it’s also necessary to check them for faults before the flight. The paramedics would do all these checks for the patients aboard the medical flight.
Each oxygen container is designed to withstand altitude up to a certain level. This must be taken into consideration before embarking on the medical journey. The expected duration of breathing and the duration of the flight are other aspects that must be considered.
Types of Oxygen Masks and Regulators
Continuous flow regulator ensures a 100% flow of oxygen. This usually contains a re-breather mask that allows the user to reuse some of the exhaled oxygen.
Demand and pressure demand works by providing oxygen to the user on demand. In other words, the oxygen only becomes available when the user is inhaling. Such oxygen usage is very stable and can be used up to 10 thousand feet above the sea level. This type of oxygen release becomes necessary in fixed wing aircraft where there travel long distances, often across continents.
‘Stringent’ is the word that comes to mind when you think of medical flight insurance coverage norms. Cost reimbursements of medical flights can mean between a retaining your life savings and letting it go to cover the huge bills. It is important to know the basis on which insurance companies accept or deny the claims. Of course, the foremost thing is to own a health insurance policy that covers medical flight services or medical transportation of any form for that matter. If this condition is taken care of, following are the other conditions that you must be mindful of.
Insurance Coverage for Medical Flight Services
Medical flight services to and from hospitals are covered by Medicare Part B. It is worthy to note here that air medical transportation to skilled nursing facilities is also covered under Part B. However, it should be noted that medical flight coverage is provided when it is deemed that ground ambulances are not suitable for the medical condition or when it is determined that the patient is in dire need of care and timely care is possible when the patient is carried to the treating facility in the shortest possible time via an air ambulance.
Approval by the Treating Professional is Necessary
The ultimate decision of whether a medical flight service is necessary lies with the treating professional who could be a physician or a paramedic attending an emergency. This decision cannot be taken by the patient and in most cases cannot be overruled either.
If the medical flight company feels that the patient might not be able to pay for its services, it can ask the patient to sign Advance Beneficiary Notice that states that the patient would be responsible for the payment in case the insurance company refuses reimbursement. The patient can refuse to sign this notice; however, if the air ambulance company goes ahead and carries the patient, he or she might still be held responsible for the payment.
Not all medical travels warrant a medical flight. When time is in your hand but the treatment for the ailment demands that you travel long distances, medical flight stretchers can be quite useful and economical. The cost of this service would be a fraction of what an air ambulance would cost you. However, there are certain points that one must keep in mind before booking a medical stretcher and we discuss those in some detail here.
How Isolated is the Patient in the Medical Flight Stretcher?
Medical stretchers naturally occupy more space than a normal seat would. Plus there might be the need of space for some basic medical equipment. All this space translates into higher cost. The agency you have hired might cut corners by trying to make do with minimum space. It is wise to clarify this beforehand. Isolation from the rest of the fight is extremely necessary.
Does the Air Ambulance Company take Care of the Logistics?
You do not want to risk taking the patient in your car to the airport. It is always wise to have an ambulance for this purpose. Does the agency take care of this? Also, the on-boarding and off-boarding of the patient must be a quick process. The agency needs to anticipate all possible hurdles to this and take care of it well in advance.
Booking the Hospital Bed on Arrival in Advance
You do not want to run around to book a bed in the hospital of your desire. While you standby the loved one with health issues, the agency must take care of booking the hospital bed in advance. It is vital that you ask about this beforehand and take confirmation of the booking. Of course, the ambulance too must be ready in the airport upon arrival to save time and get through the process quickly.
Lastly, one must not hesitate to clarify any doubts that they may have, with the coordinator.
You cannot deny the fact that a medical flight landing near your home or workplace can generate some excitement. Naturally, the inquisitive you would want to know what is happening. We all know that medical flights can perform tracheotomy to minor amputations on the spot. As a responsible person, you might want to help the injured or even the crew. As such noble thoughts run through your mind, you might not realize that you are putting yourself at risk. You might wonder how that is possible. This risk is precisely what we discuss here.
Help the Medical Flight by Helping Yourself
It takes no rocket science to understand that a medical flight or any helicopter, for that matter, needs enough space to land. In your enthusiasm, do not block the landing space. Better still, ask the fellow onlookers to make way for the medical flight to land.
Medical flights exert quite some down-thrust which can simply throw around kids, small pets, and loosely held objects. Stay away from such objects or secure them, while also holding your pets and kids so that they are safe.
Protecting your eyes from the dust that might be roused by the medical flight is important. You do not want to end up being a medical emergency yourself and burden the air ambulance crew.
Offering Personal Help is a Strict No
It is highly unlikely that bystanders are asked for help during medical flight emergencies. Do not approach the crew with an offer to help. You might simply be obstructing their work. Think of it; the crew is usually comprised of experienced paramedics, nurses, doctors and pilots who know their job well. In the event that your help is required, rest assured, they will ask for it. Unless that happens, the best thing that you can do is keep yourself out of harm’s way.
When time is of essence, no other transport is as effective as a medical flight. That said, there are limitations to this mode of medical transport too. A lot of issues also stem up owing to the fact that medical flight services are a recent addition all over the world. While they have been prevalent since decades, the extent of prevalence has shot up drastically in recent times. Here, we list a few limitations that one must be aware of.
Medical Flight Services have Limited Hours of Operation
According to law, no pilot can work more than a 12-hour shift in a day, regardless of whether he or she flies or not. Of course, some of the pilot’s time goes into the routine upkeep of flight logs, etc. but this does not necessarily mean the professional is paid less, and having several pilots is not a feasible option for most medical flight operators.
Extreme Weather Conditions can be a Problem
Think of land ambulances, their operation remains almost unaffected in any weather condition, but medical flight services are no insulated from this. Even the slightest hint sometimes can prevent their take off. It’s important to note there that haste to save a patient’s life can endanger the lives of the crew members.
Medical Flight Landing and Take Off
It is stating the obvious but airplanes naturally need proper landing facilities. Helicopters, on the other hand, can do with less space but it becomes a problem when receiving hospitals do not have a helipad, especially in urban areas, where space is always an issue.
Highly Trained Professionals are a Must
There could be two problems here. The first is finding highly experienced professionals to become crew members; this can prove tedious. Second, experience comes at a price and can, in turn, shoot up the costs.
Injuries can occur without prior warning, anytime, anywhere. It is a real possibility that you may one day find yourself in a situation where you need to care for a critically injured person until a medical flight arrives. Know that you can make a difference and there is a lot you can do to help the injured. However, first things first; call the 911 before you even attempt anything. Faster the paramedics reach the better. If the accident site is in the middle of nowhere, make that know clearly to the responder. There is a good possibility that the paramedics themselves will arrive in a medical flight for quick evacuation.
Your Role in the Meantime
The fastest that a paramedic or emergency services can arrive is 6 to 9 minutes. While these initial minutes may sound like a small time, they can prove to be the difference between life and death. The first thing to check is whether the patient is breathing normally and whether there is a wound that is letting blood out rapidly. First clamp the blood using a piece of cloth as a tourniquet. Position the patient such that the blood flow is against gravity. Administer CPR if necessary. Observe yourself; feeling stressed and nauseous in such situations is normal. Try and clear your thoughts and focus on the critical victim.
Stay Safe till the Medical Flight or Other Form of Help Arrives
Bravado is bad, especially if you are stuck with the victim in a tough terrain. The best you can do is tell the 911 responder exactly what has happened and answer the questions clearly. Apart from that ensuring that the patient is conscious by talking to them, controlling bleeding, positioning the patient right and administering CPR if necessary is the only thing that you can do. Remember, there are laws to protect you like the Good Samaritan Act that keeps you shielded from any legal liabilities in situations like these, so never shy away from helping.