Topics in Emergency Medicine

Weber, Dan ; Maré, Lori ; Battaglia, Norma J.

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The article reviews the educational foundations of the 20-year-old air medical transport industry, which are' based primarily upon models from ground-based emergency medical services, in-hospital practice standards, and military training manuals rather than research specific to civilian air medical transport. To draft a training and continuing education plan, program directors must consider cost, the available labor pool, the intended mission profile, the level of support offered by those with budgetary oversight, and the availability of local training resources. Although mandating a single, industrywide level of practice does not appear to be appropriate, air medical operations should provide their transport teams with a standardized curriculum in air physiology and a workload sufficient to maintain vital skills. The organization should also provide regular communication of its mission statement, clear demarcation of lines of authority to ensure team confidence in decision making, and regular training in air medical safety practices. The air medical transport industry must face questions regarding the validity of practice standards and questions about cost effectiveness by embracing accepted methods of research and data gathering. Such methods will greatly influence the nature of the industry in an environment of change.

Long, David

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Air medical programs are predominantly owned by, and based at, individual hospitals. Many hospitals are now collaborating to merge their flight services. The topic of air medical consortiums includes types of structures, merger negotiations, governance, medical supervision, flight dispatch, finance, and reimbursement.

Boeder, James R.

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One of the most important decisions to be made in the development of an air medical transport service is the medical crew configuration to be used. Air medical crew configurations may consist of various combinations of physicians, registered nurses, paramedics, respiratory care practitioners, and basic emergency medical technicians. The decision of which medical crew configuration will be used should be made by the air medical transport program's administration and the program medical director to ensure that the crew configuration meets the program's needs and provides optimal patient care. The medical crew configuration selected should conform to the program's mission, level of care, and patient population. The air medical crew configuration must also fit within the resources that have been allocated to the program. The statutes of the state also must be reviewed to ensure that the crew configuration conforms to the requirements of mandated regulatory bodies.

Spaite, Daniel W.; Criss, Elizabeth A.; Valenzuela, Terence D.

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The battlefields of Korea and Vietnam saw the first large-scale uses of aeromedical transport for critically wounded individuals. It was estimated that in Vietnam no soldier was more than 35 minutes from definitive care due to helicopter transport, resulting in improved outcomes from multiple trauma. Despite this success, however, it was not until 1972 that the first hospital-based aeromedical transport program was started in Denver, Colorado. Since then, the number of helicopters in the United States has grown to 200, with each generation undergoing numerous changes. Each modification has brought with it increased safety and greater patient diversity. There are specific issues related to safety, cost, patient outcome, and time savings, however, that must be considered during program development. Operational guidelines and emergency medical services (EMS) protocols must be designed to consider each of these issues in determining appropriate utilization. Research has demonstrated that rotor-wing air medical transport services have the capability of extending regional trauma services by 150 miles with safe and efficient patient care. With ongoing research, the next generation of transport systems will have a more clearly defined role and function within EMS.

Yale, Craig M.

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Considerations in the development of a structured approach to establish costs and charges and to improve reimbursement for an air ambulance provider are discussed in relation to current and future trends in the air medical industry. Special structures must be put in place to ensure that the unique characteristics of an air medical program are addressed and that the program does not become a financial burden on its sponsoring institution(s). Emphasis is placed on the need to determine the accurate cost of providing services to establish appropriate charges and for negotiations with prospective payers. Relationships between air ambulance services and their sponsors will require careful evaluation for both parties to position themselves appropriately for the future.

Kuehl, Alexander E.

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Moon, Tom ; Broome, Robert

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The most important consideration in emergency medical service air medical transport is safety. The article focuses on safety issues and considerations as they relate to air medical programs. Aviation accident trends are discussed, and suggestions are made for incorporation of a structured safety program into an air medical program.

Spaite, Daniel W.; Higie, Stephanie

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Werman, Howard A.

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Air ambulance services are a vital part of any regional emergency medical service system. The air transport system provides the critical link between local health care facilities and regional referral centers. Because of the speed of both fixed- and rotary-wing aircraft, the special equipment on board the aircraft and the special skills of the medical crew, air ambulance transports typically involve the most critically ill or injured patients within the health care system. As with any component of the emergency medical service system, each air ambulance service must have a single party or body that is responsible for the oversight of all aspects of medical care provided by the service. This is the responsibility of the medical director of each air medical service.

Frazer, Eileen

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After 4 years of research, development of standards with measurable criteria, and field tests, a voluntary accreditation process for rotor- and fixed-wing air medical services was initiated in July 1990 by the Commission on Accreditation of Air Medical Services. The Commission is a nonprofit organization incorporated in the state of Pennsylvania. The primary purpose of the Commission is to provide a voluntary evaluation process to measure compliance with accreditation standards in order to improve the quality of patient care and safety of the air transport environment in the United States and Canada. Since the Commission became operational in October 1991, 18 air medical services have achieved full accreditation, and another 22 services are in the process of completing various stages of the application process.