Helicopter Medical Transport Service: The authors reply

Abstract

We thank Dr. Cowles for his interest and will attempt to respond to his questions about program cost and the effect of air medical transport on morbidity and mortality. The latter will be addressed first. Although our study was not designed to examine differences in morbidity and mortality rates for patients transported by ground in comparison with those transported by air, some investigators have done so. Case control studies comparing trauma patients transported by helicopter with those transported by land ambulance, when stratified on the basis of severity of injury, have shown improved survival for the group transported by air.1Baxt WG Moody P Cleveland HC Fischer RP Kyes FN Leicht MJ Rouch F Wiest P Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: a multicenter study.Ann Emerg Med. 1985; 14: 859-864Abstract Full Text PDF PubMed Scopus (157) Google Scholar, 2Baxt WG Moody P The impact of a rotorcraft aeromedical emergency care service on trauma mortality.JAMA. 1983; 249: 3047-3051Crossref PubMed Scopus (246) Google Scholar, 3Moylan JA Fitzpatrick KT Beyer III, AJ Georgiade GS Factors improving survival in multisystem trauma patients.Ann Surg. 1988; 207: 679-683Crossref PubMed Scopus (70) Google Scholar Of note, the time intervals from injury to arrival at a trauma center in these reports were similar by land and by air, and the important factor in improving outcome seemed to be early delivery of highly skilled and experienced personnel to the patient. Aeromedical transport programs have, in effect, made the skills of the level I trauma center available to a much wider area than would otherwise have been possible. This advantage is particularly evident in a rural environment, where most prehospital providers are trained at the basic life support level. With regard to cost, the transport of patients by rotor wing aircraft to tertiary-care hospitals is an expensive proposition. An average flight incurs about $2,500 in actual cost, whereas the average charge to the patient in the north central United States in a 1989 survey was $1,354.41989 transport charge survey.Hosp Aviat. June 1989; 8: 19-20Google Scholar This discrepancy in charges versus actual cost has its roots in the short history of aeromedical transport. The first such program in the United States was begun only some 18 years ago, and the fee structure was set at a level commensurate with that of land-based ambulances. No data were available at that time to suggest that this mode of prehospital transport conferred advantages beyond that of traditional patient transport methods. Fortunately, as studies such as the aforementioned ones were published, the advantages of aeromedical transport have become clearer and have helped to add justification for charging appropriately for a service that hitherto has been undervalued. Currently, the charge-to-cost ratio for aeromedical transport is approaching unity in many programs nationwide. In summary, it is clear that although hospital-based transport programs are extremely expensive, they do play an important role in the prehospital and interhospital care of critically ill patients, current evidence suggesting a decline in mortality for victims of trauma. Additional studies should be undertaken for all categories of patients in an effort to identify those who are ideal candidates for air transport. Helicopter Medical Transport ServiceMayo Clinic ProceedingsVol. 65Issue 3PreviewDespite the remarkable detail presented by Farnell and Sachs in their recent article on the Mayo Clinic's helicopter emergency transport service (Mayo Clin Proc 64:1213–1225, 1989), the authors did not discuss the cost of the program or provide data showing improvements in morbidity and mortality that would justify its expense. Full-Text PDF