Benefit of air medical transport must outweigh the risk
Recent crashes remind us that EMS transport by helicopter is a high-risk procedure with little room for error
After a few years of relative quiet, the number of air medical helicopter crashes appears to be increasing again. In the somber roll call that is the 2015 National EMS Memorial honoree list, eight of the 15 EMS provider fatalities were from air medical crashes. And one air medical agency has experienced numerous crashes over a short time span, including two originating from the same base. To call the frequency of crashes “a statistical anomaly” is a bit of a stretch and requires a deeper inquiry as to the causes.
EMS transport by helicopter is a procedure, just as starting an IV, defibrillating a patient, or transporting by ground ambulance. Like all procedures, there is a certain amount of risk that is undertaken. Helicopters can arguably be placed in the “high risk” procedure category. For a high risk procedure there must be significant amount of benefit to the patient who is transported by air, in order to offset the significant amount of risk involved.
But it doesn’t seem that way. Just as ground ambulance wars are being waged across the country, air ambulance agencies are battling each other for dominance in their arena. As with any business, the need to contain costs is paramount to the bottom line. The question is, when is just enough, enough? The margin of error while in the air is very small; there is not a lot of wiggle room when trying to maintain safety.
Moreover, what is the benefit of air transport translated into lives saved and improvement of life? While it’s probable that the time saved in transit has relevance for a finite set of patients, it’s not likely to make a difference in the majority of cases. Add in the cost of an air transport, and it seems that the risk-benefit ratio of transporting non-time dependent patients is tipped very much in the wrong direction.
Some argue that it isn’t just the transport, but the level of care provided in the helicopter. Fair enough, but then it would stand to make sense that there should be an option to transport the patient by ground with the air crew on board in non-time critical incidents. However, the reality is that it’s not likely to happen.
What’s the bottom line? Medical helicopters are not designed to stay in the air by themselves. Flying missions on no notice decreases the margin on safety. Pressure to stay financially viable may worsen the safety profile. Here’s hoping that a reset of some sort within the industry will result in a better risk-benefit ratio for patients and EMS providers.