Abuse of Medical Air Transport?

[Sombeech]

So I made out with a mountain bike trail this week in San Tan Mountain Regional Park in Arizona http://www.bogley.com/forum/showthread.php?61364-Oh-Dang!-Beech-is-in-Hospital-MTB-Crash

Not only am I glad I was able to refuse the life flight - medical air transport service, but now I'm really scratching my head as to why they wanted to push that on me so hard.

My symptoms? Concussion, but my eyes were not dilated. Just some temporary memory loss, I knew who I was and where I was by the time the EMTs arrived. I had some superficial scrapes on my hands and shoulder, I was having completely coherent conversation but the time they had arrived. I was sitting up.

Take a look at the map, I had mytracks logging the route. The placemark on the left is the trailhead, and very close to where the crash was. Then you can see the route to the hospital and google calculates it to be 7 miles away. I can remember the ride in the ambulance and I know it was only a few minutes.

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The pickup point at my crash site was VERY accessible for the sheriff truck and ambulance which is seen from my video, in fact it's a double track dirt road so there's no need for going off trail to reach me.

I heard the EMT say he should get the helicopter en route and fortunately I was fully coherent and asked if I had the right to refuse that. He was taken back a bit (and I could hear the disappointment in his reaction) as he said "well technically yes you have the right to refuse but I don't suggest it". So I responded with "then I'm not flying in a helicopter to the hospital. I'm not in any life threatening danger, in fact I don't even want to be taken in an ambulance."

Well I compromised and ended up going in the weeoooo weeoooo mobile.

But seriously folks, why in the world are they trying to push the helicopter ride on me? I can understand if it's been a while and they need a training exercise but I can guarandamntee I would get the "training rate" when I got the helicopter bill.

Is it for financial gain? Panic? Maybe they didn't feel comfortable with handling me themselves? What if a real emergency would have occurred at the same time? They'd have to say "sorry, we're taking a dude with a concussion and a scrape on his hand"

[hank moon]

yay, Beech - good on ya.

A story of abuse: http://goo.gl/4vL9C
Discussion of above on Firehouse forum: http://goo.gl/PIbOV


Scaredyfish Article, "Do you have a helicopter fetish?" : http://goo.gl/QTI7l

[bbennett]

Being that the EMS helicopter is my bread and butter, I'll offer my input based solely on my experience and the fact that I'm just the monkey up front and don't know any of that medical mumbo jumbo. I don't know what the circumstances are in the area of Arizona that you were in but if it's as rural as northern Nevada (where I work), it's very possible that the level of care in the local weeooo weeooo mobile is not at the same level as that which can be provided with the helicopter crew (basic EMT's vs. RN and Paramedic with extensive trauma experience). Your head injury was a likely catalyst for their concern however, the fact that you were alert and speaking should have pacified them. I am surprised that they were considering calling out the helicopter when you were only 7 miles from the hospitol though. By the time that they were alerted and airborne, you could very well have already been at, or close to the ER.
We usually aren't even considered unless the patient is at least 10 miles outside of the city. We are always called (outside of 10 miles) for respiratory and cardiac patients. Head injuries also fall into the "high alert" category but do not warrant an automatic dispatch.
Was it a revenue thing? Maybe, but usually the helicopter and the ambulance aren't part of the same company. You definitely made the right decision though. To give you an idea of what your cost might have been (before insurance), I think my company charges around $12K to launch and then charges by mileage and services rendered during transport. So a $20k bill would not be unlikely.
I need to check with IHC to see if they have a membership program. If they do, I would highly encourage everyone to sign up. The company that I work at charges $50 per year for their membership. What this means is if you're a member, and need transport via air ambulance, it costs you nothing other than your $50 membership fee. This covers your entire family. $20K vs. 50 bucks is a no brainer.
I'm glad you're doing well Justin. Those videos were awesome!

[Sombeech]

Just to give you an idea of my condition at the time of arrival:

[canyonphile]

Hmmm...interesting question!

As a former and happily retired physician, the first thing that jumped into my mind re the pressure to take the spendy heli ride was "litigation mitigation". Seriously - no one involved with your care wants to get sued, and if you'd ended up having some brain bleed that happened really fast and ultimately caused you to become vegetative or deceased, a personal injury lawyer somewhere would try and pin all the blame on not getting you to the hospital fast enough and name everyone who participated in your treatment on the med-mal lineup.

I say this wearing the doctor's hat and having been sued (unsuccessfully, I might add ) while I was in practice.

If I were in your position, I'd absolutely refuse the copter ride as well. Seems overkill, and in your case, it clearly would have been. But, if I were the EMT on the scene, I'd probably err on the side of caution and urge you to take the $10K ride instead of the $2K version.

I'm not sure how much financial incentive there is here...after all, your insurance co could say after the fact that the heli ride was unnecessary and refuse to pay for it. They could try and stick you with the bill, but really, who on EARTH could actually afford to pay for that out of their own pocket? Not anyone I know! So, at the risk of losing some major coin on a trip that won't get paid for, I'd say $$ is low. But, I could be totally wrong...it's happened before !

[denaliguide]

litigation mitigation? that must be doctor speak for "covering his ass". which i am sure is what the emt was doing, and i can't blame him for that. i have seen ambulance crews respond to a minor wreck and just throw the sink at the victims. neck braces and backboards in even minor fender benders. it is just their protocol to over treat any injuries and assume the worst case scenario. you can't get sued for over treating, but if you undertreat and something goes wrong then thats when the shit hits the fan.

[DOSS]

Having spent my time in the back of the bus as an EMT more often than not the decision is made by the on call doctor at the hospital whether or not to bring in air med (That as well as standing protocols on obvious spinal injury's and severe head trauma). It was SOP for both Gold Cross in Salt Lake and the Grantsville/Tooele departments that prior to loading a patient to consult the on call doctor at the hospital the patient would be delivered to. That said there were quite a few docs that seemed afraid of any kind of head injury and wanted air med the second we would mention that they bumped their head at all...

[dbaxter]

Head injuries are so unpredictable. You can actually be up walking and talking afterwards, then suddenly slip into a coma. I wouldn't be too hard on them, even though I would also have refused if it were me. It's just so hard to make those decisions in the field (I would imagine) knowing that the wrong one could impact someone's life in a real negative way.

So glad to hear you're doing ok

[ratagonia]

You hit the ground hard enough to produce a concussion = hard enough to break a neck vertebra or produce a traumatic brain injury. EMT has to work with very limited information to make a call quickly. If there is a physician on the phone he has even less information. Ground EMT might want to hand it off to the Flight EMT as soon as possible - then it's their problem!

Good goin' Beech. Obviously, they can work with a strong declining of the heli ride, especially when within a few miles of the hospital. If the hospital was 30 miles away, they might have insisted.

Did they X-Ray you at the hospital? head and neck?

T