By David Wahlberg
The Wisconsin State Journal
DANE COUNTY, Wis. — Emergency medical services in Dane County are reducing requests for Med Flight, UW Hospital’s helicopter service, in the wake of a deadly crash a year ago.
Paramedics are no longer asking Med Flight to respond to some cardiac arrests, said Dr. Paul Stiegler, medical director of Dane County EMS.
The agency also may ask law enforcement officials to delay requesting Med Flight for some traffic crashes — instead letting paramedics at the scene decide if a chopper is needed, Stiegler said.
The moves are in response to the Med Flight crash near La Crosse, which killed its crew of three on May 10, as well as eight similar crashes nationally that killed 32 people from December 2007 to October 2008, he said. The Med Flight crew will be honored today with the dedication of a memorial.
“We’re trying to not put Med Flight in the air when we don’t need to because of the safety factor,” Stiegler said.
The type of flight Med Flight conducts most — patient transfers between hospitals — also might be curtailed because insurance companies nationally are questioning the expense, an industry observer said. Transfers by ambulance generally are cheaper.
“I would not be surprised if the (helicopter) hospital transfers have already decreased or will decrease in the future because of increased cost scrutiny,” said Mark Huber, the Wisconsin-based rotorcraft editor for Aviation International News.
Dr. Ryan Wubben, interim medical director of Med Flight, said the type of cardiac arrest requests to be curtailed make up 12 to 20 of the service’s 1,300 or so flights a year. Traffic crashes account for many more flights, Wubben said, but he said he couldn’t provide an estimate or predict the total impact of the changes.
“Sometimes there’s under-calling (for Med Flight), and sometimes there’s over-calling,” he said. “That’s part of the nature of what we do.”
Hospital transfers are 80 percent of Med Flight’s calls, and trauma scene responses account for 20 percent, Wubben said.
Only helicopters can provide the speedy transfers between hospitals that some patients need, Wubben said. Doctors aboard Med Flight can care for patients with complicated medical conditions better than emergency medical technicians in ambulances, he said.
Change in February
The Dane County EMS Commission’s medical advisory committee decided in February to stop requesting Med Flight for adults in cardiac arrest who don’t have traumatic injuries, Stiegler said.
The risk of helicopter flights isn’t the only reason for the change, he said.
Paramedics are trying to rescue patients using cardiocerebral resuscitation, or CCR. The technique, which uses chest compressions but not breaths, has been gradually replacing cardiopulmonary resuscitation, or CPR.
CCR relies more than CPR on the quality of chest compressions, so the technique is better performed on land, not in a helicopter, Stiegler said.
If a patient’s pulse returns, paramedics might ask Med Flight to take the patient to the hospital, he said.
The medical advisory committee also is considering decreasing the use of Med Flight at trauma scenes, Stiegler said. Police officers and sheriff’s deputies sometimes call Med Flight to traffic crashes when the injuries aren’t serious enough to warrant it, he said.
“We want to assess what is going on with the patients before calling Med Flight,” he said.
Cause uncertain
A year after the fatal Med Flight crash, the National Transportation Safety Board has not released a probable cause.
UW Hospital leaders will dedicate an art glass memorial today to the crew: Dr. Darren Bean, nurse Mark Coyne and pilot Steve Lipperer.
The men left Madison to deliver an 86-year-old patient from Prairie du Chien to Gundersen Lutheran Hospital in La Crosse because that hospital’s helicopter was busy. The patient died a few hours later at the hospital.
The Med Flight crew then took off from the La Crosse airport for Madison at night in foggy, rainy weather, crashing at the top of a wooded ridge.
Lipperer flew visually. He couldn’t fly by instruments because Air Methods, which leases helicopters to Med Flight, hadn’t recertified him to do so, said NTSB documents released in January. Lipperer had been certified to fly by instruments by CJ Systems, which was acquired by Air Methods in 2007.
All Med Flight pilots, who are employed by Air Methods, were recertified to fly by instruments shortly after the incident, company officials have said.
The NTSB said weather conditions didn’t require instruments but were worse than preferred for visual navigation. Other emergency helicopter services in the area turned down flights because of the weather.
The helicopter that crashed didn’t have two pieces of safety equipment recommended by the NTSB: night-vision goggles and a terrain warning system, which can alert pilots before an impact. The two helicopters currently used by Med Flight have the equipment, Wubben said.
Seven Med Flight physicians have chosen not to fly since the crash, he said. Four others have joined the service and three more will begin in July.
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