As rural emergency rooms close and specialty care becomes more centralized in big cities, moving patients in from rural areas fast has become more important in emergency medicine. Helicopters are the only rapid way that 28% of the nation's population can get to a top trauma center within 60 minutes, according to a study published in the June issue of the Journal of the American Medical Association. "Medical helicopters and their flight crews are of tremendous importance to the nation, especially rural Americans," says the study's lead author, Charles Branas, an assistant professor of epidemiology at the University of Pennsylvania School of Medicine. So while emergency medical services officials don't want to limit access to helicopters, they are concerned about the crashes and they want to protect their patients. Applying safety standards is particularly important, industry officials say, because no two air ambulance operations are exactly alike. Two distinct approaches for providing the service have emerged. The long-standing approach is to base a helicopter at a specialty hospital http://medicaljets.wallinside.com a trauma, cardiac or burn center and send hospital specialists to patients to bring them back to the hospital. These operations tend to use expensive helicopters with top-notch navigational instruments and safety gear, as well as highly experienced pilots. Because these helicopters are more expensive to own and operate, and because the pilots and medical personnel are paid well, these operations typically lose money on each flight. They stay afloat through financial support from the hospital, which makes money by maintaining a steady flow of incoming patients. The more recent approach, which continues to grow across the nation, is to base a helicopter in a rural area so that it is closer to the prospective patients. Because these operators stand alone in a community with little or no financial support, each helicopter must earn a profit to stay in the area. These operators use helicopters that are less expensive to own and operate and lack the more sophisticated safety features of the typical hospital-based helicopter, such as calibrated navigational instruments that help pilots fly in poor visibility. Both their pilots and their medical crews tend to be less experienced than those at a traditional hospital-based operation. "We've grown so fast in this industry that we've outpaced our ability to have that level of personnel on a consistent basis," says Christine Zalar, a former flight nurse and an industry consultant with Fitch & Associates. "We've also placed aircraft in areas where those kinds of people don't exist. You are working in an area that makes great sense because patients need to be moved but your talent pool in that area is a little more stretched." Today there are hybrids of both types of operations with hospitals deploying helicopters in rural areas and freestanding aviation companies operating helicopters at hospitals. But for the most part, the differences are still significant, says Bob Bass, Maryland's EMS medical director, who is part of a nationwide effort by the air ambulance industry, health regulators and emergency physicians to help state officials craft air ambulance rules. "The larger carriers are trying to run a quality program and pay their pilots and pay their mechanics and run safely, and they are feeling they are being undercut by these other programs doing it on the cheap," he says. Reducing the number of flights Meanwhile, across the EMS field, there is a sense of urgency as emergency workers try to apply more logic to airlifts. Marble Falls has never had any concern about its helicopter crew's safety, but the accidents across the nation have paramedics here scrutinizing the performance of the many helicopters in the area and finding ways to reduce the number of times patients have to be loaded onto helicopters. Waving off a chopper in a small town like Marble Falls means making a tough and complicated decision fast. After the helicopter set up its base in town, anytime an ambulance responded to find a victim near death, the medics called for the chopper.
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