A missive from the Association of Air Medical Services (AAMS) notes that the medical helicopter industry has come under great public scrutiny recently - particularly regarding safety and appropriate usage concerns - but also in relation to questions over foreign-travel access and evacuation-insurance coverage, which have been prompted by the tragic death of award-winning actress Natasha Richardson from a traumatic brain injury after a fall on a Canadian ski slope.

To help the public better understand the issues, AAMS is conducting a public education campaign regarding the importance of air medical transport in our nation, particularly in rural and other underserved areas.

"Most people don't realize the life-and-death role that emergency medical helicopters play in our healthcare system," said Sandy Kinkade, president of AAMS. "But the critically ill and injured are airlifted once every 90 seconds in our nation. That's why it's important to have medevac services in places where they are needed - because the life saved might be yours or a loved one's."

Kinkade would like to remind the American public of the following facts related to air-medical services:

• Medevac helicopters provide both a higher level of medical care (than is typically found on a ground ambulance), as well as a speedier response. The crews on medical helicopters are highly sophisticated, with physician-level capabilities. A typical crew consists of a specially-trained critical care nurse and a paramedic but can also include other specialists (such as a neonatologist or respiratory therapist) as necessitated, depending on the patient's condition.
• Almost exclusively, these crews handle the most critically ill and injured patients, thus giving them more experience in dealing with severe cases than typical ground EMS responders.
• Medevac crews - coupled with the advanced drugs, blood and blood products, as well as the sophisticated patient monitoring tools and equipment they have on board - typically bring a higher level of medical intervention than is sometimes available in the area, which may only be served by primary-care facilities. This is especially true in outlying areas, where air-medical services have formed a "rural healthcare safety net" for underserved communities or cities experiencing budget cuts.
• Medevac helicopter crews do not "self-dispatch"; the request for an air medical transport is generally made by a physician, nurse, law-enforcement officer, fire-service crew member, ground ambulance paramedic or other certified emergency medical personnel as dictated by local, regional or state protocols.
• Increased medevac helicopter usage is partially the result of aging "baby boomers," whose related health care problems - most notably stroke and heart attack - are placing a greater demand on the overall healthcare system as well as creating a need for highly time-dependent emergency-medical response.
• Greater reliance on medevac helicopters is particularly prevalent in rural and sunbelt retirement areas and in places that have experienced emergency department closures or cutbacks in local, community-based ambulance services.
• Changes in the Centers for Medicare & Medicaid Services (CMS) Medicare payment structure have resulted in a lack of rural trauma and tertiary care centers. In addition, shortages of specialist physicians have frequently necessitated distant transport. These factors, combined with the federal Emergency Medical Treatment and Active Labor Act (EMTALA) mandate that requires physicians to stabilize patients to the maximum of their ability, and to assure continuation of a high level of care if transport to a tertiary-care facility is required, factor significantly in inter-facility transport decisions.

AAMS is well aware of the recent intolerable increase in fatal medical helicopter crashes, and as a result has put forward several proposals aimed at making medevac flights safer. Chief among these  proposals is that all medical night-flight operations be required to either utilize night vision goggles (NVGs) or similar enhanced-vision systems, or be conducted strictly under instrument flight rules (IFRs), in a timeline established by the Federal Aviation Administration (FAA) and in coordination with air medical service providers.

In addition, AAMS is recommending that Congress expedite funding for hospital helipads, enhanced off-airport weather reporting and global positioning systems (GPS) technologies, and other initiatives aimed at improving the low-altitude aviation infrastructure.

"As the tragic story of actress Natasha Richardson, who died from a traumatic brain injury after falling on a Canadian ski slope, has illustrated, medevac helicopters play a vital role in our nation's health care system - and around the world - by offering speed, access, safety and quality of patient care," said Kinkade.

"The Obama administration has recognized that it is imperative we address our nation's crumbling infrastructure by finding ways to quickly implement beneficial new technologies - and that philosophy should also extend to the low-altitude aviation infrastructure. As the recent intolerable medevac helicopter accident rate has demonstrated, immediate improvements are needed in the current medical helicopter operating environment, and AAMS is committed to making the changes necessary to improve safety."

FMI: www.aams.org