One of the most informative aviation-related blogs online today is ‘Flying Lessons’, by Christine Negroni.
Started in late 2009, ‘Flying Lessons’ covers all sorts of aviation content, from light/fun/curious travel details, to very serious air safety issues. The latter has included numerous articles about the profit/risk imbalance (and lack of adequate regulation) in the helicopter EMS industry. If you are concerned about the HEMS problem, be sure to read these posts.
An 11/16/10 article has the title Helicopter Ambulances: The better-safe-than-sorry scare tactic. Ms. Negroni notes that the rate of HEMS accidents is so high that, comparatively, it would be equal to an airline disaster every day … and yet this level of carnage is accepted as the cost of doing business. She also provides a clear example of how HEMS fees appear to be at the root of the problem; how the profits gleaned from exorbitant billings are causing safety failures (her example includes a billing, for an unnecessary night-time helicopter transport, charging a $12,150 base rate and an additional $135 per mile flown). Here is a copy of the bulk of her article…
…I’m talking about the business of medical transport and the price paid by patients who are moved by air.
Last week, Nanci Wilson of KXAN in Austin, Texas reported on the case of Oscar Vaz. His 12-year old daughter bumped her head at summer camp in June. Now that’s not news; everyone knows that bumps, bruises and bug bites are part of the camp experience like campfires and ghost stories. Only in this case the camp called for an ambulance, and it wasn’t the four-wheeled variety that showed up it was a helicopter. After a brief visit to the hospital, the girl was released back to camp with a clean bill of health and not long after that, Oscar Vaz received a bill for $16,000.
What the better-safe-than-sorry philosophy costs
Oscar is one smart daddy and he started to wonder just what motivated such a drastic response to a simple bump on the noggin. What factors led to the decision to bundle the child into a helicopter and on to Dell Children’s Medical Center?
Critical attention from a doctor couldn’t have been the issue since the helicopter flew right past two hospitals located closer to the camp. And there was no stated need for some highly sophisticated medical technology only available at the medical center in Austin. Oscar was mystified.
“If it is important enough to call an air ambulance, then why not go to the hospital that’s 30 minutes away?” he asked me rhetorically when he called this summer.
I didn’t know Oscar then. He came across some of the many articles I’ve written on this subject when he started researching air ambulances. He got in touch because he was trying to understand the money machine that is today’s for-profit air ambulance business.
But Oscar didn’t need much from me. He was already asking the right questions. When the bill arrived, Oscar asked why the 9-11 dispatchers called – then cancelled – Starflight, the Travis County public service helicopter, a taxpayer-supported service which would have cost considerably less, and instead dispatched the for-profit air ambulance Air Evac? If speed was the issue, why did it take the 90 minutes to get the child to the Austin hospital which is only a 50 minute drive from the camp?
Surely, Oscar thought, there must be some standard operating procedure used for determining when an air ambulance is needed and when it is not especially considering that medical helicopters are themselves, not particularly safe.
What Oscar didn’t know – and if you ask me, it’s a good thing for his peace of mind that he did not – is that the period of time in which his daughter was flown; the hours between 10 pm and 6 am or what’s called “backside of the clock“ are the most dangerous hours to fly by helicopter medivac. Nearly half of all the EMS helicopter crashes take place during this time and they are almost four times more likely to result in fatalities than helicopter accidents occurring during the day. So Oscar and his daughter had two things to be thankful for; No medical problems and no unhappy landing.
But there is that whopping bill from Air Evac. And I think that Oscar, and others who have been transported by air unnecessarily feel companies like Air Evac are playing them for fools.
Their complaints, however, always get reduced to the argument that they are better-safe-than-sorry, that air transport is worth the cost because, after all, a life is on the line. This is the bread and butter scare tactic used by the helicopter ambulance industry and you don’t have to go farther than the comment section on this blog to read the endless varieties on that theme.
But one thing aviation does well is the cost benefit analysis and this better-safe-than-sorry argument doesn’t hold up to that scrutiny. So before Americans go any farther embracing the booming business of air ambulances, its critically important to analyze how the industry got cross-wise with safety and study the programs that seem to be doing things right….
Another article, posted 10/18/11, has the title And the (woomph, woomph, woomph) Beat Goes On. It describes a powerful safety presentation by former air ambulance pilot Randy Mains, crusading for effective safety regulation in the HEMS industry. Here is an excerpt:
…What’s unambiguous is the fact that patients and medical workers have been killed in these helicopters by the score.
And here to help you visualize that is former air ambulance pilot, Randy Mains who spent this morning bringing the truth on home at the Air Medical Transport Conference in St. Louis. First he distributed to the audience hundreds of envelopes telling the medical aviators to just hang on, they could open them shortly.
Randy is on a mission making speeches and writing about how to make HEMS operations safer.
“I have watched in despair for over 32 years as the HEMS system in the U.S. has become more and more dangerous to where it is now officially the most dangerous job in America .”
Finally, the people in the audience with envelopes were asked to stand, 346 of them, about half of people in the room. Inside each envelope was the name of someone who died in a medical helicopter crash.
Randy’s wife Kaye described what happened next. “All you could hear was the tearing of envelopes. People really were in the moment and looking around, absorbing it. It was about two minutes with people standing. There was an overwhelming feeling.”
“It was very satisfying, “ Randy said, describing the stunt – a bit of dramatics intended to energize the people who do not want to imagine their own names on such a slip of paper in the future.
“We must design our programs in the States like they do it in Europe and Canada where they have excellent safety records,” he said ticking off the requirements outside of the United States; two pilots with current instrument-ratings and night vision goggles, in twin-engine aircraft. “Aviation safety doesn’t care about egos, bottom lines or competition. It only works if it is done right.”
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Use this link HEMS articles at ‘Flying Lessons’ to see Christine Negroni’s other HEMS posts.
“…please don’t call the casualties “heroes” or “fallen angels”. Call them evidence that the public has been bamboozled into believing we need to be flying around by air even when the injury is not life threatening, just in case. And call them victims of an industry that’s off-the-radar, fueled with cash and powerfully incentivized to keep on doing it just this way.”
– from a 7/23/10 post, at ‘Flying Lessons’