Regionalization of health careRegionalization of health care

Matching supply to demandMatching supply to demand

Maximizing resource allocationMaximizing resource allocation

National Trauma Centers NetworkNational Trauma Centers Network Critical Care CentersCritical Care Centers Organ Transplant regional modelsOrgan Transplant regional models

Ground transportGround transport

Good newsGood newsCheapCheapUbiquitousUbiquitousAdequate for initial responseAdequate for initial response

Bad newsBad newsSlow, affected by trafficSlow, affected by trafficNot cost effective to provide widespread ALSNot cost effective to provide widespread ALSNot cost effective to include physiciansNot cost effective to include physicians

Rescue HelicoptersRescue Helicopters

Good news:Good news: Rapid responseRapid response Mobile ALS capabilityMobile ALS capability Cost effective to carry physiciansCost effective to carry physicians

Bad news:Bad news: Expensive- Expensive- $5,000 to $10,000 a trip$5,000 to $10,000 a trip Affected by weatherAffected by weather Places to land in the city Places to land in the city

Helicopters are beneficialHelicopters are beneficialfor selected patientsfor selected patients

In adjusted analysis, helicopter transport was found to be associated with a significant mortality reduction. Conclusion : The results of this study are consistent with an association between helicopter transport mode and increased survival in blunt trauma patients.

Thomas, St, et al. J Trauma-Injury Infection & Critical Care. 52(1):136-145, January 2002.

Helicopters are riskyHelicopters are risky

47 accidents in 5 years. 40 fatalities and 36 injuries. 13 helicopter types involved. 70% were attributed to pilot error.

The number of accidents increased from a low of 4 in 1997 to a maximum of 12 in both 2000 and 2001.

Bledsoe BE. Pre-hospital Emergency Care 2003 Jan-Mar;7(1):94-8. 

Risky to helicopter personnelRisky to helicopter personnel

“ “crew members, who work 20 hours a crew members, who work 20 hours a week for 20 years would face a 40% week for 20 years would face a 40% chance of being involved in a fatal crash”chance of being involved in a fatal crash”

Susan Baker PhD. Johns Hopkins Bloomberg School of Public Health.Susan Baker PhD. Johns Hopkins Bloomberg School of Public Health.

Helicopters don’t necessarily transport Helicopters don’t necessarily transport critically ill patientscritically ill patients

69.3% of patients had a greater than 90% chance of 69.3% of patients had a greater than 90% chance of survival. 25.8% of patients discharged within 24 hours survival. 25.8% of patients discharged within 24 hours after trauma center arrival.after trauma center arrival.• Bledsoe, B et al. J Trauma 2006 Jun;60(6):1257-65. 

37,500 helicopter transported patients determined that 67% had only minor injuries. 25% had injuries too minor to require hospital admission. • Prehospital Emergency Care. Jan 2005.

How effective in “Saving Lives”?How effective in “Saving Lives”?

Stanford University trauma surgeon Clayton Shatney conducted a study of Stanford University trauma surgeon Clayton Shatney conducted a study of 947 Patients flown to Santa Clara Valley Medical Center and concluded that 947 Patients flown to Santa Clara Valley Medical Center and concluded that Helicopter service potentially saved the lives of only nine of them -- While Helicopter service potentially saved the lives of only nine of them -- While potentially serving as detriment to five who could have arrived faster by potentially serving as detriment to five who could have arrived faster by ground.ground.

Shatney, CH et al. J Trauma 2002 Nov;53(5):817-22. 

Critical Care Transports: “Scoop & Run” Critical Care Transports: “Scoop & Run” vs “Stay and Play”vs “Stay and Play”

Good news: Physician, CCM Nurse & technologist on boardPhysician, CCM Nurse & technologist on board High tech monitoringHigh tech monitoring

Intra aortic balloon pumpIntra aortic balloon pump

Bad news: ExpensiveExpensive Time consumingTime consuming Improved outcome?Improved outcome?

HELLIKER, K FUHRMANS V. Air Ambulances Are Under Fire. THE WALL STREET JOURNAL March 3, 2005

* “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,"

* David Crippen, MD Associate professor Critical Care Medicine University of Pittsburgh Medical Center.