Emergency Medical Service: Justifying the Helicopter

Economics continually force hospital managers to weigh the payoff of an air medical helicopter. The answer depends on how you define payoff.

In weighing what hospital executives should consider in deciding whether investment in a helicopter air ambulance is justified, you are confronted with a fundamental question: why bother?

After all, there hasn't been a new, hospital-based helicopter program launched in the United States in a decade or so, experts in the field note. The trend is heavily toward independent operators setting up community-based programs that work ad hoc with area hospitals or migrate over time to closer and more formal working relationships with them. Neither federal reimbursements or private insurance practices seem likely to increase the margins of health care in general, let alone overhead-laden operations like a flight program.

That is all certainly is true. Yet there are plenty of good reasons to explore whether an air medical program makes sense for a health care facility, a reality highlighted by continual queries from hospital managers on the matter.

Consider a few examples.

The high costs of health care force many smaller hospitals to shut down. They are replaced in suburban and rural communities by even smaller, understaffed emergency-care facilities that have little capability or capacity and less appetite for complicated cases, let alone severe ones. Staff at such facilities are quick to call for transport of such patients to higher-level care facilities, by air if available, by lengthy ground-ambulance runs if need be.

Steady advances in the technology of health care make more successful interventions available to wider groups of patients, both acute and chronic. The helicopter emergency medical service industry may have sprung from the lessons of the Vietnam War about trauma care and widespread understanding of the critical "golden hour." But today advances in cardiac, pediatric, and neo-natal care mean the patient in the back may have suffered no trauma at all. With pharmacological advances such as thrombolytics, for instance, that patient may have suffered a stroke, the ill effects of which might be reversed entirely with a speedy transport. The potential of technological advances is nowhere near exhausted.

While hospitals may opt not to have any sort of flight program, they have an abiding interest in the quality of clinical care provided to patients who may arrive at their facilities entirely or in part by air. The best way to assure that quality may be a sound working relationship with the local flight program or programs.

Those factors, combined with regionalization of health care, may mean a large medical center discovers numerous reasons for increasing professional links with smaller, outlying facilities that hinge on swift transport of patients among them.

For these and other reasons, experts say, savvy hospital administrators should always have a fresh and detailed grasp of how an air medical program might support their institution's goals.

"There's a matrix of questions you have to address" toward that end, said Ed Marasco, senior vice president of air medical services for CJ Systems Aviation (which is being bought by Air Methods Corp.). He spent 13 years as a hospital administrator and customer of air medical services before joining CJ Systems. The first questions to start off with are: "Does the community need the service of an air medical program? Are we the right entity to provide it?"

He said he is contacted once a month or so by some hospital executive weighing the question of starting or expanding an air medical program or dropping or altering the one in place.