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Air wars: Who wins?

Editor's note: Seven medical helicopter companies now serve the counties in this region of Ohio, Kentucky and Indiana. How much is too much? Editorial Advisor Art Hsieh explains his take on the competitive industry of air medical transport.

As the debate continues about the efficacy of transporting patients to hospitals using medical helicopters, stories like this one seem to fly right in the face of the discussion. I mean really, is there so much demand for air medical services that six or seven units are needed in one area? As you might guess from previous commentary, I think that there are several issues with this scenario:

1) Evidence — it's not especially clear if there is any data to support air transport of many, if not most patients.

2) Cost — $17,000 per flight, and up? Insurance pays for that right? Um, maybe...and then who covers the insurance company? Right — everyone who has a policy with them.

3) Experience — like the same argument about ground-based ALS, can too many flight crews reduce the overall experience level of the flight crews? After all, there are only so many patients that require interventions performed at the level of a physician or flight nurse.

4) Safety — this almost can go unsaid. With new mandates and greater scrutiny on the decision making processes of flight pilots, crews and operators, a situation where air crews compete for the minds and hearts of ground personnel for calls has the potential to exacerbate an already volatile situation.

Now, to be fair, perhaps there was a reason for competitors to come into the area. It's possible that the existing provider was not able to provide sufficient coverage to the area, and was either unable or unwilling to expand its service. I'll assume that someone looked at some real data that supported the assertion and put together a plan that responded to that gap. But, I am assuming, and you know what THAT means....

In the end, I recognize my rants won't change things very much. What would work are the EMS folks who work and live in that area having a heartfelt discussion about the efficacy and safety of their work practices and culture of patient transport.

Set aside the rhetoric and really consider what is best for the patient, balanced against the safety risk and cost associated with air transport. That debate will have the greatest potential for change.

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