I agree with you, and posters above. I'd be flying myself to a trauma center to save my thumb, and time is an issue with amputations, obviously. For all we know he was 200 miles away from the surgeon.
Helicopter Usage
- Thread starter vc85
- Start date
I agree with you, and posters above. I'd be flying myself to a trauma center to save my thumb, and time is an issue with amputations, obviously. For all we know he was 200 miles away from the surgeon.
long post
Was the patient a concert pianist or surgeon? What was the ischemic time prior to transport? warm or chilled? If the patient got there 30 minutes earlier, would the pt actually get treated 30 minutes earlier or would the patient get there before the surgeon was ready?
Digits last longer than other parts of the body. Generally, replantation within 24 hours (chilled) is considered viable. One hospital was able to get 64% success for patients over 24hours. Others have worse than 50% success with an average of 5.6hours.
Lets suppose that the chance of a successful outcome decreases 0.1 percent per minute. This is not to be confused with 0.1 percentage points per minute: 1000 minutes is 37% survival not 0%; i.e. this is exponential decay, not linear. This is loosely based on the very limited random data points I could find for finger replantation success vs duration of ischemia. This simple model suggests that a 30 minute shorter transport would improve the patients outcome by about 3%. This estimate may be a bit on the high side.
At $20,000 per trip (just using number tossed out by someone else in thread, it might be high for the mileage), you have to air transport 33 patients to save one thumb for a cost of $660,000. That is about 10 times what a thumb is considered worth in terms of disability payments. 100% loss of thumb gets a payout equivalent to about 75 weeks disability (2/3 wages) or about 1 year of income. If the surgery is successful, the pt will probably have 50% motion/sensation in thumb and so will get half that disability, anyway, so the benefit of the helicopter ride is equal to one half years wages for one out of 33 patients. So, the average benefit to the pt of this intervention is about 0.75 weeks wages, perhaps $750, at a cost of $20,000.
In court, there have been some outlandish awards in cases where a handinjury resulted from malice, but a median award for a hand injury is about $70,000 and the lawyer probably got a third of that; so the courts probably are pretty similar to disability.
$660,000 might buy an ambulance and staff it for a year. How does the benefit they could provide compare to the saving on one thumb? There are also other potential life saving measures out there that could safe a life, not merely a thumb, for less than $660,000.
Maybe the patients loss is considerably greater than the potential compensation. But so, too, might be the losses that this same money might otherwise prevent if it were used in other areas.
Maybe the same helicopter transporting the same patient to a hospital on the other side of the state with a better hand surgeon might perhaps increase the cost by a factor of two (if the number wasn't already inflated a bit) but also increase the average benefit by a factor of 10. Even ground transport across the state might improve the patients outcome as outcome seems to vary more with surgeon than it does with time.
Maybe if you don't use the helicopter for less deserving calls like this, it sits on the ground burning up money, anyway. Maybe instead of billing for 100 calls at $20K each, you bill for 10 calls at $200K each. So maybe the insurance companies and government utlimately are paying for the helicopter and we might as well get as much benefit out of it as we can. Or maybe we should really only look at the marginal cost per transport and not include the overhead costs.
And maybe we can reduce, but not eliminate, the helicopter availability issue by taking the thumb patient but if a more important call comes in, the helicopter takes it and ditches the pt with the ground ambulance on scene. Issues with being closer to some critical patients and further from others and potential fuel/supply usage or flying out of response area.
Was the patient a concert pianist or surgeon? What was the ischemic time prior to transport? warm or chilled? If the patient got there 30 minutes earlier, would the pt actually get treated 30 minutes earlier or would the patient get there before the surgeon was ready?
Digits last longer than other parts of the body. Generally, replantation within 24 hours (chilled) is considered viable. One hospital was able to get 64% success for patients over 24hours. Others have worse than 50% success with an average of 5.6hours.
Lets suppose that the chance of a successful outcome decreases 0.1 percent per minute. This is not to be confused with 0.1 percentage points per minute: 1000 minutes is 37% survival not 0%; i.e. this is exponential decay, not linear. This is loosely based on the very limited random data points I could find for finger replantation success vs duration of ischemia. This simple model suggests that a 30 minute shorter transport would improve the patients outcome by about 3%. This estimate may be a bit on the high side.
At $20,000 per trip (just using number tossed out by someone else in thread, it might be high for the mileage), you have to air transport 33 patients to save one thumb for a cost of $660,000. That is about 10 times what a thumb is considered worth in terms of disability payments. 100% loss of thumb gets a payout equivalent to about 75 weeks disability (2/3 wages) or about 1 year of income. If the surgery is successful, the pt will probably have 50% motion/sensation in thumb and so will get half that disability, anyway, so the benefit of the helicopter ride is equal to one half years wages for one out of 33 patients. So, the average benefit to the pt of this intervention is about 0.75 weeks wages, perhaps $750, at a cost of $20,000.
In court, there have been some outlandish awards in cases where a handinjury resulted from malice, but a median award for a hand injury is about $70,000 and the lawyer probably got a third of that; so the courts probably are pretty similar to disability.
$660,000 might buy an ambulance and staff it for a year. How does the benefit they could provide compare to the saving on one thumb? There are also other potential life saving measures out there that could safe a life, not merely a thumb, for less than $660,000.
Maybe the patients loss is considerably greater than the potential compensation. But so, too, might be the losses that this same money might otherwise prevent if it were used in other areas.
Maybe the same helicopter transporting the same patient to a hospital on the other side of the state with a better hand surgeon might perhaps increase the cost by a factor of two (if the number wasn't already inflated a bit) but also increase the average benefit by a factor of 10. Even ground transport across the state might improve the patients outcome as outcome seems to vary more with surgeon than it does with time.
Maybe if you don't use the helicopter for less deserving calls like this, it sits on the ground burning up money, anyway. Maybe instead of billing for 100 calls at $20K each, you bill for 10 calls at $200K each. So maybe the insurance companies and government utlimately are paying for the helicopter and we might as well get as much benefit out of it as we can. Or maybe we should really only look at the marginal cost per transport and not include the overhead costs.
And maybe we can reduce, but not eliminate, the helicopter availability issue by taking the thumb patient but if a more important call comes in, the helicopter takes it and ditches the pt with the ground ambulance on scene. Issues with being closer to some critical patients and further from others and potential fuel/supply usage or flying out of response area.
ERDoc
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You've got 6-12 hours from the time of the injury. There really is no need for a helicopter.
redundantbassist
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Sounds like you're just a hypothetical jerk...
RedAirplane
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Here's the real question. Why do helicopters cost so much to the poor patient? Are they trying to get repeat business from a STEMI?
There are models of air ambulance that do not bill the end user. CHP. All the trooper medics in Maryland. Virgin pays for London Air Ambulance in UK. Why can't we make this issue work so you never have to face the awful choice of $$ vs limb? That's got to be medically doing harm to a patient.
There are models of air ambulance that do not bill the end user. CHP. All the trooper medics in Maryland. Virgin pays for London Air Ambulance in UK. Why can't we make this issue work so you never have to face the awful choice of $$ vs limb? That's got to be medically doing harm to a patient.
ERDoc
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In the end, someone is paying for it. You just have to decide how you want to divide the costs. Should the community pay for it through taxes or should the users pay for it through billing? It is not cheap to run/staff a helicopter, especially one that isn't prone to crashing.
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The first two are not exactly known for their medical robustness either. Charitable trusts for rescue helicopters are common in other countries, but someone is still paying for it.
RedAirplane
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Not denying the cost.
It just seems like extortion to Bill the person who is sick.
Maryland pays for their choppers with a $17 fee every time you register a car.
Easier to swallow than 17K for one person.
It just seems like extortion to Bill the person who is sick.
Maryland pays for their choppers with a $17 fee every time you register a car.
Easier to swallow than 17K for one person.
ERDoc
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I guess it all depends on if you are liberal, conservative or libertarian.
NPO
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I believe the answer would be how long is the thumb viable. If, for example, the thumb was 100% viable for 96 hours, then no the flight probably isn't justifiable. But if the thumb is only viable for a few hours or less, then yes, its justified.
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While I cannot speak to the medical robustness of the MSP, I can speak a little about the ability of the CHP. Their helicopters are primarily a law enforcement tool that are staffed with a single paramedic. This classifies them as a "rescue" helicopter and not an "air ambulance" so they're limited that way. While they do not bill the patient, they also don't transport patients as a primary duty. For them, they will if they must. I would imagine that the MSP helicopters are staffed the same way and have similar capability issues. Yes, the CHP will transport to a hospital, but if they do it, it's usually because the other transport options are worse in the long run.
EMDispatch
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MSP does serve as the primary air medical transport in the state, and are running with 2 flight medics on the helicopters now. From my understanding of it all, they receive their funding from the state, and there is also a $17.00 yearly charge on Maryland vehicle registrations to supplement the cost. If the system is depleted, they can call on private air units, and you will be billed.
DesertMedic66
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In my neck of the woods we will call in and get the ETA of our 2 local HEMS units. If they are too far out or are not flying we will call CHP.
CHP in my area rarely has a medic on board. Usually it will just be an EMT that is on board. In my county paramedics can not hand over patient care to a BLS provider this causes either the fire medic and/or the ambulance medic to fly in with the patient.
RedAirplane
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My instructor was a CHP paramedic and he did plenty of transports for trauma, chest pain, etc. But yes, they are primarily rescue.
MSP is well described above. Incidentally also the first civilian medevac in the country.
MSP is well described above. Incidentally also the first civilian medevac in the country.
CALEMT
The Other Guy/ Paramaybe?
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So just out of curiosity and I'm sure this has happened before, but could helicopter 301 (Cal Fire) out of Hemet Ryan transport? There should be a medic on board, but with very limited supplies. I know sometimes they fly their rescues off the bump n grind.
DesertMedic66
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Ive heard different things. I've heard that 301 is not staffed with a medic (no clue at all if that's true or not). And I have also heard that 301 is too heavy to land on the roof of the trauma center.
I think they would rather send SBCoSD helicopter which is staffed with a medic, RN, PA, or doctor who primarily do medical runs.
CALEMT
The Other Guy/ Paramaybe?
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You know now that I'm thinking about it, it might be hit or miss for the medic. I can only guess on staffing for helitack (I was a engine slug) but I know theres 2 Capts. (permanent) and I want to say the all firefighters are seasonal's so there may or may not be a medic.
Im with ya on SBCoSD, its a rescue and a transport choppa I believe its crossed staffed between FD and SO. I know they've flown people from TC's up in Victorville and rescued people around the Big Bear area.
DesertMedic66
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The actual sheriffs helicopter is staffed with reserve deputies who are trained as medics or volunteers. I know a couple of people at AMR redlands who fly for them and the director of my paramedic program flues for them also.