Air ambulances: costly, dangerous, slow?

According to today's Wall St. Journal, not only are air ambulances liable to crash (a crew member who worked 20 hours/week for 20 years would have a 40% chance of being killed), they are often slower than ground ambulances, and are used to transport patients who aren't that sick.

The conventional wisdom is that air ambulances save the lives of patients who are too critically ill to withstand a slower ride in a ground ambulance. Yet some observers of the industry say medical air transports actually save very few lives -- while costing as much as 10 times more than ground ambulances. A number of published studies including research at Stanford University and the University of Texas, show that the flights often transport minimally injured patients when ground transport frequently could get them to a hospital faster, and with less risk to others.

"In 20 years of experience in urban critical-care helicopter transport, I can count on the fingers of one hand the number of times I thought flying a patient to the hospital made a significant difference in outcome compared to lights and siren," says David Crippen, an associate professor of critical care and emergency medicine at University of Pittsburgh Medical Center.

Of course, there are situations where air ambulances make sense, such as in rural areas. On the other hand, even speedy air ambulances can't do much about the 10-20 hours waits I mentioned in yesterday's post on Mass General.

After 9-year-old Tyler Herman fell and broke his jaw in the wilds of Arizona, doctors at a community hospital decided the boy should fly to Phoenix to undergo plastic surgery for a gash on his face. During the flight he was well enough to sit up and remark on the scenery. Upon arriving in Phoenix, he waited nearly 20 hours to undergo surgery. "We could have driven him there in four hours," says Sharon Herman, the boy's mother. Her insurance didn't cover air transport, leaving the Hermans with a bill for $25,000.